{"hospital_name":"OSF Saint Anthony Medical Center","last_updated_on":"2026-03-31","version":"3.0.0","location_name":["OSF Saint Anthony Medical Center"],"hospital_address":["5666 East State Street, Rockford, IL 61108"],"license_information":{"license_number":"0002253","state":"IL"},"type_2_npi":["1790739977"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Mary Beth Brown"},"financial_aid_policy":["40% off of facility standard gross charges."],"standard_charge_information":[{"description":"OLANZAPINE 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-4112-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.28,"discounted_cash":19.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON 4 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-077-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.74,"discounted_cash":8.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":57.89,"discounted_cash":34.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57664-683-31","type":"NDC"}],"standard_charges":[{"gross_charge":80.32,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58160-815-43","type":"NDC"}],"standard_charges":[{"gross_charge":198.15,"discounted_cash":118.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58160-820-43","type":"NDC"}],"standard_charges":[{"gross_charge":112.7,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58160-842-52","type":"NDC"}],"standard_charges":[{"gross_charge":166.70,"discounted_cash":100.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58160-959-01","type":"NDC"}],"standard_charges":[{"gross_charge":388.3,"discounted_cash":232.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59630-266-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59630-266-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-484-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59676-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":78.97,"discounted_cash":47.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59746-113-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59746-171-06","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-1705-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55566-8403-1","type":"NDC"}],"standard_charges":[{"gross_charge":18.72,"discounted_cash":11.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-2038-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-4630-3","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ABIRATERONE ACETATE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-4764-6","type":"NDC"}],"standard_charges":[{"gross_charge":507.25,"discounted_cash":304.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6120-6","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6130-0","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6130-5","type":"NDC"}],"standard_charges":[{"gross_charge":7.10,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6132-7","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6142-0","type":"NDC"}],"standard_charges":[{"gross_charge":10.28,"discounted_cash":6.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.64,"discounted_cash":6.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6142-5","type":"NDC"}],"standard_charges":[{"gross_charge":9.64,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 10 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6143-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/115ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6143-4","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":269.65,"discounted_cash":161.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6146-0","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6146-4","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6147-0","type":"NDC"}],"standard_charges":[{"gross_charge":31.48,"discounted_cash":18.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-2039-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.42,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6147-4","type":"NDC"}],"standard_charges":[{"gross_charge":31.48,"discounted_cash":18.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DENOSUMAB 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55513-710-21","type":"NDC"}],"standard_charges":[{"gross_charge":92.02,"discounted_cash":55.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-365-01","type":"NDC"}],"standard_charges":[{"gross_charge":150.62,"discounted_cash":90.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 30 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":378.37,"discounted_cash":227.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TENECTEPLASE 50 MG IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-120-47","type":"NDC"}],"standard_charges":[{"gross_charge":432.36,"discounted_cash":259.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-527-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.52,"discounted_cash":5.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN IMMUNE FAB 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50633-120-11","type":"NDC"}],"standard_charges":[{"gross_charge":14578.97,"discounted_cash":8747.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXOCOBALAMIN 5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50633-310-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.87,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-520-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.80,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-1200-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.20,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-1200-3","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-4000-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-4020-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE PF 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54288-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.01,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.78,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54288-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54288-119-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.00,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TARLATAMAB-DLLE 10 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55513-077-01","type":"NDC"}],"standard_charges":[{"gross_charge":4396.54,"discounted_cash":2637.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54288-142-10","type":"NDC"}],"standard_charges":[{"gross_charge":105.24,"discounted_cash":63.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54879-022-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-527-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-678-11","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":21.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-680-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.92,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-685-07","type":"NDC"}],"standard_charges":[{"gross_charge":58.56,"discounted_cash":35.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-116-20","type":"NDC"}],"standard_charges":[{"gross_charge":43.65,"discounted_cash":26.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-117-20","type":"NDC"}],"standard_charges":[{"gross_charge":31.42,"discounted_cash":18.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAFCILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-123-15","type":"NDC"}],"standard_charges":[{"gross_charge":0.45,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-154-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-164-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":34.40,"discounted_cash":20.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.6,"discounted_cash":35.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-194-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-233-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.00,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54288-147-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6148-0","type":"NDC"}],"standard_charges":[{"gross_charge":34.88,"discounted_cash":20.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6148-4","type":"NDC"}],"standard_charges":[{"gross_charge":34.30,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6157-0","type":"NDC"}],"standard_charges":[{"gross_charge":23.1,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-229-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.96,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-265-30","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-269-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-269-67","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-273-01","type":"NDC"}],"standard_charges":[{"gross_charge":176.9,"discounted_cash":106.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.65,"discounted_cash":18.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-280-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.15,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-280-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.1,"discounted_cash":19.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-285-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPIVACAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-294-27","type":"NDC"}],"standard_charges":[{"gross_charge":29.55,"discounted_cash":17.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-295-61","type":"NDC"}],"standard_charges":[{"gross_charge":32.42,"discounted_cash":19.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-314-61","type":"NDC"}],"standard_charges":[{"gross_charge":38.35,"discounted_cash":23.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":33.49,"discounted_cash":20.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":266.71,"discounted_cash":160.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":74.05,"discounted_cash":44.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":476.65,"discounted_cash":285.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":183.0,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":167.45,"discounted_cash":100.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":388.10,"discounted_cash":232.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":385.21,"discounted_cash":231.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":136.31,"discounted_cash":81.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-229-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.48,"discounted_cash":8.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GANCICLOVIR SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":74.71,"discounted_cash":44.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-325-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-325-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-325-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.77,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-325-14","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-325-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.70,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAFCILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-328-21","type":"NDC"}],"standard_charges":[{"gross_charge":84.62,"discounted_cash":50.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-341-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.05,"discounted_cash":27.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-341-41","type":"NDC"}],"standard_charges":[{"gross_charge":33.85,"discounted_cash":20.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-342-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.12,"discounted_cash":20.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-342-25","type":"NDC"}],"standard_charges":[{"gross_charge":34.22,"discounted_cash":20.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-342-41","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":13.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-360-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-360-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-314-66","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-229-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.28,"discounted_cash":8.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOXINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-180-00","type":"NDC"}],"standard_charges":[{"gross_charge":38.35,"discounted_cash":23.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-173-02","type":"NDC"}],"standard_charges":[{"gross_charge":54.97,"discounted_cash":32.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6157-4","type":"NDC"}],"standard_charges":[{"gross_charge":23.1,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6159-0","type":"NDC"}],"standard_charges":[{"gross_charge":20.13,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6159-4","type":"NDC"}],"standard_charges":[{"gross_charge":20.12,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-122-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-134-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.43,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-145-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-494-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-718-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-773-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61703-309-06","type":"NDC"}],"standard_charges":[{"gross_charge":71.75,"discounted_cash":43.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61703-309-16","type":"NDC"}],"standard_charges":[{"gross_charge":31.12,"discounted_cash":18.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61958-2002-2","type":"NDC"}],"standard_charges":[{"gross_charge":219.7,"discounted_cash":131.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REMDESIVIR 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61958-2901-2","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-619-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.45,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOPROSTENOL SODIUM 0.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62756-059-40","type":"NDC"}],"standard_charges":[{"gross_charge":66.2,"discounted_cash":39.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOPROSTENOL SODIUM 1.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62756-060-40","type":"NDC"}],"standard_charges":[{"gross_charge":56.50,"discounted_cash":33.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62756-233-01","type":"NDC"}],"standard_charges":[{"gross_charge":150.10,"discounted_cash":90.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-172-60","type":"NDC"}],"standard_charges":[{"gross_charge":34.91,"discounted_cash":20.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-165-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.57,"discounted_cash":12.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-162-00","type":"NDC"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":19.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":104.5,"discounted_cash":62.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-117-68","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.22,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OBINUTUZUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":242.17,"discounted_cash":145.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-106-02","type":"NDC"}],"standard_charges":[{"gross_charge":22.05,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISPLATIN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-103-64","type":"NDC"}],"standard_charges":[{"gross_charge":14.98,"discounted_cash":8.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-064-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":6.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":6.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-010-03","type":"NDC"}],"standard_charges":[{"gross_charge":16.69,"discounted_cash":10.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-010-02","type":"NDC"}],"standard_charges":[{"gross_charge":37.51,"discounted_cash":22.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-106-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.65,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALTEPLASE 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-044-13","type":"NDC"}],"standard_charges":[{"gross_charge":258.19,"discounted_cash":154.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALTEPLASE 2 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-041-64","type":"NDC"}],"standard_charges":[{"gross_charge":273.09,"discounted_cash":163.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49281-215-58","type":"NDC"}],"standard_charges":[{"gross_charge":144.7,"discounted_cash":86.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-345-42","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-547-31","type":"NDC"}],"standard_charges":[{"gross_charge":7.08,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-548-42","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-689-31","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-689-41","type":"NDC"}],"standard_charges":[{"gross_charge":4.22,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24201-010-50","type":"NDC"}],"standard_charges":[{"gross_charge":132.77,"discounted_cash":79.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-052-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.37,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-109-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.55,"discounted_cash":25.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-121-20","type":"NDC"}],"standard_charges":[{"gross_charge":21.27,"discounted_cash":12.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-184-82","type":"NDC"}],"standard_charges":[{"gross_charge":76.9,"discounted_cash":46.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-184-87","type":"NDC"}],"standard_charges":[{"gross_charge":45.78,"discounted_cash":27.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-191-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-191-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-207-51","type":"NDC"}],"standard_charges":[{"gross_charge":25.68,"discounted_cash":15.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-345-33","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-305-20","type":"NDC"}],"standard_charges":[{"gross_charge":167.99,"discounted_cash":100.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-318-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-400-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.87,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-402-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARGATROBAN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-414-50","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-461-10","type":"NDC"}],"standard_charges":[{"gross_charge":36.28,"discounted_cash":21.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.50,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-502-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.9,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-608-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.33,"discounted_cash":2.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.08,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-608-51","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.39,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-676-20","type":"NDC"}],"standard_charges":[{"gross_charge":204.52,"discounted_cash":122.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.65,"discounted_cash":18.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.27,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-313-82","type":"NDC"}],"standard_charges":[{"gross_charge":19.59,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-313-31","type":"NDC"}],"standard_charges":[{"gross_charge":113.45,"discounted_cash":68.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-294-41","type":"NDC"}],"standard_charges":[{"gross_charge":37.02,"discounted_cash":22.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-294-31","type":"NDC"}],"standard_charges":[{"gross_charge":38.55,"discounted_cash":23.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3404-85","type":"NDC"}],"standard_charges":[{"gross_charge":22.78,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3408-80","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3408-95","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":10.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3540-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OLANZAPINE 10 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-9105-72","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-9261-95","type":"NDC"}],"standard_charges":[{"gross_charge":22.78,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6624-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.91,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6836-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6923-61","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0944-0493-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.05,"discounted_cash":132.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0955-1003-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.53,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0990-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":66.4,"discounted_cash":39.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.2,"discounted_cash":39.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10019-075-87","type":"NDC"}],"standard_charges":[{"gross_charge":7.63,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLEVIDIPINE 50 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10122-611-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.20,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLEVIDIPINE 50 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10122-611-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CANGRELOR TETRASODIUM 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10122-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.11,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-258-32","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-240-41","type":"NDC"}],"standard_charges":[{"gross_charge":30.40,"discounted_cash":18.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"19515-810-41","type":"NDC"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYALURONIDASE HUMAN 150 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"18657-117-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYALURONIDASE HUMAN 150 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"18657-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-526-63","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-815-30","type":"NDC"}],"standard_charges":[{"gross_charge":21.49,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-526-08","type":"NDC"}],"standard_charges":[{"gross_charge":0.86,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-094-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.9,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-042-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 0.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-041-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.1,"discounted_cash":6.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"15054-1120-4","type":"NDC"}],"standard_charges":[{"gross_charge":233.64,"discounted_cash":140.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"14789-116-07","type":"NDC"}],"standard_charges":[{"gross_charge":320.3,"discounted_cash":192.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"14789-116-05","type":"NDC"}],"standard_charges":[{"gross_charge":320.3,"discounted_cash":192.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-295-12","type":"NDC"}],"standard_charges":[{"gross_charge":22.48,"discounted_cash":13.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-377-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-826-82","type":"NDC"}],"standard_charges":[{"gross_charge":144.45,"discounted_cash":86.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-284-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-848-58","type":"NDC"}],"standard_charges":[{"gross_charge":74.70,"discounted_cash":44.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-931-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.14,"discounted_cash":16.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":41.51,"discounted_cash":24.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-251-05","type":"NDC"}],"standard_charges":[{"gross_charge":313.52,"discounted_cash":188.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":285.88,"discounted_cash":171.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-251-90","type":"NDC"}],"standard_charges":[{"gross_charge":313.14,"discounted_cash":187.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-251-91","type":"NDC"}],"standard_charges":[{"gross_charge":288.26,"discounted_cash":172.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-310-25","type":"NDC"}],"standard_charges":[{"gross_charge":306.83,"discounted_cash":184.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-310-90","type":"NDC"}],"standard_charges":[{"gross_charge":313.70,"discounted_cash":188.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-436-05","type":"NDC"}],"standard_charges":[{"gross_charge":273.73,"discounted_cash":164.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-437-10","type":"NDC"}],"standard_charges":[{"gross_charge":271.22,"discounted_cash":162.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-437-91","type":"NDC"}],"standard_charges":[{"gross_charge":277.23,"discounted_cash":166.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-438-20","type":"NDC"}],"standard_charges":[{"gross_charge":269.79,"discounted_cash":161.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRAND NAME ONLY PRIVIGEN 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-438-92","type":"NDC"}],"standard_charges":[{"gross_charge":266.42,"discounted_cash":159.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":273.05,"discounted_cash":163.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-848-11","type":"NDC"}],"standard_charges":[{"gross_charge":94.22,"discounted_cash":56.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAZIDIME 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-236-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-240-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.90,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-241-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":8.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-410-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-437-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.03,"discounted_cash":17.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-611-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-611-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-620-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-621-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-621-24","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-702-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.32,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-706-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":6.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-802-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 40 GM/400ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44206-439-93","type":"NDC"}],"standard_charges":[{"gross_charge":272.86,"discounted_cash":163.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-549-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-405-16","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":9.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-405-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.81,"discounted_cash":9.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.10,"discounted_cash":9.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-306-60","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.22,"discounted_cash":21.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-308-10","type":"NDC"}],"standard_charges":[{"gross_charge":53.58,"discounted_cash":32.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":6.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-322-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39822-0190-1","type":"NDC"}],"standard_charges":[{"gross_charge":106.34,"discounted_cash":63.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39822-1100-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":28.91,"discounted_cash":17.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.98,"discounted_cash":28.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.71,"discounted_cash":5.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-159-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.90,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.64,"discounted_cash":17.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-164-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":30.25,"discounted_cash":18.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-164-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.47,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-164-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.82,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-164-89","type":"NDC"}],"standard_charges":[{"gross_charge":12.32,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-168-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":125.25,"discounted_cash":75.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-130-74","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-128-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-061-11","type":"NDC"}],"standard_charges":[{"gross_charge":54.29,"discounted_cash":32.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43066-360-20","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"discounted_cash":9.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43066-150-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.44,"discounted_cash":18.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-048-24","type":"NDC"}],"standard_charges":[{"gross_charge":23.18,"discounted_cash":13.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43066-023-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43066-016-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":284.85,"discounted_cash":170.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42494-415-25","type":"NDC"}],"standard_charges":[{"gross_charge":113.74,"discounted_cash":68.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42494-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":96.22,"discounted_cash":57.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-221-10","type":"NDC"}],"standard_charges":[{"gross_charge":188.89,"discounted_cash":113.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":186.43,"discounted_cash":111.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43066-023-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3238-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-400-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZTREONAM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-203-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.30,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-203-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.94,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-203-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.75,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-303-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.96,"discounted_cash":18.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-402-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-402-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-403-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-403-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-404-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-410-84","type":"NDC"}],"standard_charges":[{"gross_charge":8.96,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-410-88","type":"NDC"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-411-80","type":"NDC"}],"standard_charges":[{"gross_charge":7.73,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-422-95","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-427-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-432-80","type":"NDC"}],"standard_charges":[{"gross_charge":11.01,"discounted_cash":6.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-432-81","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-433-82","type":"NDC"}],"standard_charges":[{"gross_charge":8.71,"discounted_cash":5.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-433-83","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-434-84","type":"NDC"}],"standard_charges":[{"gross_charge":8.67,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-434-85","type":"NDC"}],"standard_charges":[{"gross_charge":7.24,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-435-86","type":"NDC"}],"standard_charges":[{"gross_charge":7.53,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-435-87","type":"NDC"}],"standard_charges":[{"gross_charge":5.87,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-436-88","type":"NDC"}],"standard_charges":[{"gross_charge":7.28,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-436-89","type":"NDC"}],"standard_charges":[{"gross_charge":5.77,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-437-91","type":"NDC"}],"standard_charges":[{"gross_charge":6.37,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-438-93","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-411-82","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-600-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.30,"discounted_cash":19.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-203-04","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.67,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-203-02","type":"NDC"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":16.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.35,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70436-019-82","type":"NDC"}],"standard_charges":[{"gross_charge":68.68,"discounted_cash":41.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPTIFIBATIDE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70436-026-80","type":"NDC"}],"standard_charges":[{"gross_charge":97.14,"discounted_cash":58.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPTIFIBATIDE 75 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70436-027-80","type":"NDC"}],"standard_charges":[{"gross_charge":78.12,"discounted_cash":46.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70436-147-80","type":"NDC"}],"standard_charges":[{"gross_charge":141.6,"discounted_cash":84.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70436-232-52","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70461-024-04","type":"NDC"}],"standard_charges":[{"gross_charge":241.9,"discounted_cash":145.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70512-843-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70594-076-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.47,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70594-076-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.86,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70594-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.48,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70594-111-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70748-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70748-175-30","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70842-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70842-120-06","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70860-781-41","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70860-781-43","type":"NDC"}],"standard_charges":[{"gross_charge":4.69,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-404-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-2003-2","type":"NDC"}],"standard_charges":[{"gross_charge":6.79,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-016-15","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-026-75","type":"NDC"}],"standard_charges":[{"gross_charge":38.21,"discounted_cash":22.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.82,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-030-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-164-50","type":"NDC"}],"standard_charges":[{"gross_charge":27.98,"discounted_cash":16.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEMETREXED DISODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-166-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEMETREXED DISODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-167-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-201-85","type":"NDC"}],"standard_charges":[{"gross_charge":21.49,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70860-781-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.31,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-719-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.18,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-719-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-807-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-7737-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.72,"discounted_cash":10.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 10 UNITS/0.1 ML FOR IV PUSH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-8215-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.52,"discounted_cash":8.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":15.04,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-8315-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.70,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-8715-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.78,"discounted_cash":5.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BELATACEPT 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-0371-13","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ABATACEPT 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-2187-13","type":"NDC"}],"standard_charges":[{"gross_charge":174.13,"discounted_cash":104.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPILIMUMAB 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-2327-11","type":"NDC"}],"standard_charges":[{"gross_charge":710.63,"discounted_cash":426.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPILIMUMAB 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-2328-22","type":"NDC"}],"standard_charges":[{"gross_charge":705.95,"discounted_cash":423.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIVOLUMAB 240 MG/24ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-3734-13","type":"NDC"}],"standard_charges":[{"gross_charge":130.46,"discounted_cash":78.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":93.95,"discounted_cash":56.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIVOLUMAB 40 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-3772-11","type":"NDC"}],"standard_charges":[{"gross_charge":94.16,"discounted_cash":56.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIVOLUMAB 40 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-3774-12","type":"NDC"}],"standard_charges":[{"gross_charge":93.78,"discounted_cash":56.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0003-7125-11","type":"NDC"}],"standard_charges":[{"gross_charge":748.64,"discounted_cash":449.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAMUCIRUMAB 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-7678-01","type":"NDC"}],"standard_charges":[{"gross_charge":214.38,"discounted_cash":128.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0005-2000-02","type":"NDC"}],"standard_charges":[{"gross_charge":779.25,"discounted_cash":467.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEMBROLIZUMAB 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0006-3026-01","type":"NDC"}],"standard_charges":[{"gross_charge":171.20,"discounted_cash":102.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEMBROLIZUMAB 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0006-3026-04","type":"NDC"}],"standard_charges":[{"gross_charge":169.84,"discounted_cash":101.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0008-0923-51","type":"NDC"}],"standard_charges":[{"gross_charge":39.58,"discounted_cash":23.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0008-0923-55","type":"NDC"}],"standard_charges":[{"gross_charge":40.2,"discounted_cash":24.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0008-0923-60","type":"NDC"}],"standard_charges":[{"gross_charge":39.08,"discounted_cash":23.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0008-4001-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.36,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIGECYCLINE 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0008-4990-19","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIGECYCLINE 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0008-4990-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.08,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0011-03","type":"NDC"}],"standard_charges":[{"gross_charge":66.52,"discounted_cash":39.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0011-04","type":"NDC"}],"standard_charges":[{"gross_charge":71.40,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0018-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0039-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.77,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0039-28","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0039-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0005-2000-10","type":"NDC"}],"standard_charges":[{"gross_charge":812.35,"discounted_cash":487.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAMUCIRUMAB 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-7669-01","type":"NDC"}],"standard_charges":[{"gross_charge":214.13,"discounted_cash":128.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-7533-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.62,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-7510-17","type":"NDC"}],"standard_charges":[{"gross_charge":20.01,"discounted_cash":12.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-808-77","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71839-111-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.50,"discounted_cash":8.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-054-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-264-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-266-07","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VORICONAZOLE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72266-131-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.70,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72266-163-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.95,"discounted_cash":9.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72266-163-06","type":"NDC"}],"standard_charges":[{"gross_charge":15.90,"discounted_cash":9.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72266-248-01","type":"NDC"}],"standard_charges":[{"gross_charge":160.8,"discounted_cash":96.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":173.46,"discounted_cash":104.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72266-248-05","type":"NDC"}],"standard_charges":[{"gross_charge":175.46,"discounted_cash":105.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72485-417-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.38,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72485-417-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.38,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72611-860-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.15,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72611-860-04","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75907-190-07","type":"NDC"}],"standard_charges":[{"gross_charge":14.80,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76045-009-96","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-7510-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"I-131 SODIUM IODIDE CAP, PER MCI DX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0000-0003-06","type":"NDC"}],"standard_charges":[{"gross_charge":858.8,"discounted_cash":515.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0635","type":"RC"},{"code":"0069-1308-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.50,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"83634-451-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.50,"discounted_cash":17.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"83257-005-41","type":"NDC"}],"standard_charges":[{"gross_charge":511.84,"discounted_cash":307.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"8290-306414","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70121-1719-1","type":"NDC"}],"standard_charges":[{"gross_charge":21.79,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLIXIMAB-ABDA 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"78206-162-99","type":"NDC"}],"standard_charges":[{"gross_charge":220.99,"discounted_cash":132.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-8261-0","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-3390-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":47.95,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-3340-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-3318-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.07,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHYTONADIONE 1 MG/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-1240-1","type":"NDC"}],"standard_charges":[{"gross_charge":99.8,"discounted_cash":59.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLIXIMAB-ABDA 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"78206-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":221.60,"discounted_cash":132.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70121-1574-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70121-1573-5","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70121-1573-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-516-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-518-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-518-77","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 25000-5 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-522-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-562-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-578-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.50,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.74,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-579-05","type":"NDC"}],"standard_charges":[{"gross_charge":133.36,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-614-00","type":"NDC"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":27.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-614-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.09,"discounted_cash":35.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-651-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.18,"discounted_cash":5.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-658-20","type":"NDC"}],"standard_charges":[{"gross_charge":703.2,"discounted_cash":421.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-694-04","type":"NDC"}],"standard_charges":[{"gross_charge":27.87,"discounted_cash":16.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-506-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.56,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.38,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-694-22","type":"NDC"}],"standard_charges":[{"gross_charge":28.05,"discounted_cash":16.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-696-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-739-12","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":28.94,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-806-13","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-806-50","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-851-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.06,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.23,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-851-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.08,"discounted_cash":7.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-885-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.88,"discounted_cash":17.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-963-41","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-965-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-965-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.14,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-965-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-ABBS 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63459-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":247.68,"discounted_cash":148.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-ABBS 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63459-104-50","type":"NDC"}],"standard_charges":[{"gross_charge":248.23,"discounted_cash":148.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-694-41","type":"NDC"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-495-07","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":34.26,"discounted_cash":20.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-495-04","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":23.85,"discounted_cash":14.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZTREONAM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-401-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.30,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-403-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.71,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-403-02","type":"NDC"}],"standard_charges":[{"gross_charge":20.6,"discounted_cash":12.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-411-18","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-434-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-434-41","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-464-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.90,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-464-17","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-464-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-466-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-466-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-466-17","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-466-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-474-00","type":"NDC"}],"standard_charges":[{"gross_charge":34.11,"discounted_cash":20.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-478-27","type":"NDC"}],"standard_charges":[{"gross_charge":0.28,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-481-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-482-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":35.97,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-57","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":24.12,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-45","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":27.7,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":47.12,"discounted_cash":28.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-27","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":23.74,"discounted_cash":14.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.81,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":30.93,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-04","type":"NDC"}],"standard_charges":[{"gross_charge":3.35,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":28.48,"discounted_cash":17.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63833-386-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.83,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-487-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":66.95,"discounted_cash":40.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.23,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":62.63,"discounted_cash":37.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-487-17","type":"NDC"}],"standard_charges":[{"gross_charge":0.60,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-487-07","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":53.64,"discounted_cash":32.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-485-26","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":29.42,"discounted_cash":17.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-482-57","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":59.91,"discounted_cash":35.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-482-27","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":36.99,"discounted_cash":22.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-400-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63833-387-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.70,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63833-397-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.79,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE 16 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-559-69","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-155-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZATHIOPRINE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-229-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.51,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 0.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-449-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":6.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.50,"discounted_cash":8.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-907-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":10.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIROLIMUS 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-915-95","type":"NDC"}],"standard_charges":[{"gross_charge":43.53,"discounted_cash":26.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-918-95","type":"NDC"}],"standard_charges":[{"gross_charge":14.15,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":100.52,"discounted_cash":60.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-469-40","type":"NDC"}],"standard_charges":[{"gross_charge":11.28,"discounted_cash":6.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-621-02","type":"NDC"}],"standard_charges":[{"gross_charge":33.12,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-622-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.43,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":15.74,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-622-64","type":"NDC"}],"standard_charges":[{"gross_charge":16.40,"discounted_cash":9.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-557-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-896-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.27,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-708-31","type":"NDC"}],"standard_charges":[{"gross_charge":16.08,"discounted_cash":9.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.30,"discounted_cash":9.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-708-96","type":"NDC"}],"standard_charges":[{"gross_charge":16.48,"discounted_cash":9.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.62,"discounted_cash":9.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69918-700-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.78,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69918-899-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.75,"discounted_cash":34.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69918-901-10","type":"NDC"}],"standard_charges":[{"gross_charge":39.83,"discounted_cash":23.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-728-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-728-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-788-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.11,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-788-04","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70121-1049-1","type":"NDC"}],"standard_charges":[{"gross_charge":13.08,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70121-1049-5","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-168-48","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON 4 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-246-16","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":60.36,"discounted_cash":36.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67919-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.69,"discounted_cash":47.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GRANISETRON HCL 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-863-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-570-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.92,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-572-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-572-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.82,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65250-266-09","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.47,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65250-266-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66689-307-08","type":"NDC"}],"standard_charges":[{"gross_charge":30.4,"discounted_cash":18.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66794-204-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66794-219-63","type":"NDC"}],"standard_charges":[{"gross_charge":35.4,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66993-730-51","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-182-00","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-218-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.38,"discounted_cash":17.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-220-05","type":"NDC"}],"standard_charges":[{"gross_charge":71.68,"discounted_cash":43.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-339-00","type":"NDC"}],"standard_charges":[{"gross_charge":47.7,"discounted_cash":28.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.95,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-855-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-855-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.19,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-675-02","type":"NDC"}],"standard_charges":[{"gross_charge":6032.75,"discounted_cash":3619.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-658-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.89,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-528-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.98,"discounted_cash":25.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-433-22","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63833-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-433-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":28.81,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-428-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.17,"discounted_cash":5.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-426-00","type":"NDC"}],"standard_charges":[{"gross_charge":28.41,"discounted_cash":17.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-423-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.20,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-423-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-420-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-339-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.95,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-428-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0047-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.51,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAZIDIME 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3177-80","type":"NDC"}],"standard_charges":[{"gross_charge":26.48,"discounted_cash":15.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3059-95","type":"NDC"}],"standard_charges":[{"gross_charge":33.19,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0663-04","type":"NDC"}],"standard_charges":[{"gross_charge":76.62,"discounted_cash":45.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0669-04","type":"NDC"}],"standard_charges":[{"gross_charge":79.85,"discounted_cash":47.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0671-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.60,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 30-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0673-04","type":"NDC"}],"standard_charges":[{"gross_charge":77.4,"discounted_cash":46.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0675-04","type":"NDC"}],"standard_charges":[{"gross_charge":79.85,"discounted_cash":47.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CL IN DEXTROSE 5% 20 MEQ/L IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0683-04","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0691-04","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0695-04","type":"NDC"}],"standard_charges":[{"gross_charge":4.13,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0703-41","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0704-34","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0705-48","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0803-04","type":"NDC"}],"standard_charges":[{"gross_charge":81.92,"discounted_cash":49.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 40-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0807-04","type":"NDC"}],"standard_charges":[{"gross_charge":77.89,"discounted_cash":46.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0811-04","type":"NDC"}],"standard_charges":[{"gross_charge":82.25,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0553-18","type":"NDC"}],"standard_charges":[{"gross_charge":67.6,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9159-30","type":"NDC"}],"standard_charges":[{"gross_charge":70.92,"discounted_cash":42.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":71.53,"discounted_cash":42.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9540-02","type":"NDC"}],"standard_charges":[{"gross_charge":186.84,"discounted_cash":112.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9540-06","type":"NDC"}],"standard_charges":[{"gross_charge":178.6,"discounted_cash":107.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9543-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.8,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":65.78,"discounted_cash":39.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9543-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.58,"discounted_cash":40.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":67.6,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9543-05","type":"NDC"}],"standard_charges":[{"gross_charge":69.66,"discounted_cash":41.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9543-06","type":"NDC"}],"standard_charges":[{"gross_charge":70.05,"discounted_cash":42.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-9791-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.71,"discounted_cash":37.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 250 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0409-1775-40","type":"NDC"}],"standard_charges":[{"gross_charge":63.03,"discounted_cash":37.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIANEAL LOW CALCIUM/1.5% DEX 344 MOSM/L IP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0941-0409-01","type":"NDC"}],"standard_charges":[{"gross_charge":216.17,"discounted_cash":129.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIANEAL LOW CALCIUM/1.5% DEX 344 MOSM/L IP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0941-0409-06","type":"NDC"}],"standard_charges":[{"gross_charge":148.15,"discounted_cash":88.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIANEAL LOW CALCIUM/1.5% DEX 344 MOSM/L IP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0941-0424-53","type":"NDC"}],"standard_charges":[{"gross_charge":174.11,"discounted_cash":104.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIANEAL LOW CALCIUM/2.5% DEX 395 MOSM/L IP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0941-0430-51","type":"NDC"}],"standard_charges":[{"gross_charge":148.11,"discounted_cash":88.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIANEAL LOW CALCIUM/2.5% DEX 395 MOSM/L IP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0941-0430-53","type":"NDC"}],"standard_charges":[{"gross_charge":162.81,"discounted_cash":97.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0519-09","type":"NDC"}],"standard_charges":[{"gross_charge":188.45,"discounted_cash":113.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0125-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.60,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0264-7800-10","type":"NDC"}],"standard_charges":[{"gross_charge":60.28,"discounted_cash":36.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":60.3,"discounted_cash":36.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0264-7800-20","type":"NDC"}],"standard_charges":[{"gross_charge":59.1,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":59.05,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0017-02","type":"NDC"}],"standard_charges":[{"gross_charge":63.27,"discounted_cash":37.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0017-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.84,"discounted_cash":37.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0017-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.43,"discounted_cash":40.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0017-18","type":"NDC"}],"standard_charges":[{"gross_charge":56.00,"discounted_cash":33.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0017-41","type":"NDC"}],"standard_charges":[{"gross_charge":58.45,"discounted_cash":35.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0017-48","type":"NDC"}],"standard_charges":[{"gross_charge":56.50,"discounted_cash":33.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0023-02","type":"NDC"}],"standard_charges":[{"gross_charge":68.85,"discounted_cash":41.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0023-03","type":"NDC"}],"standard_charges":[{"gross_charge":67.6,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0023-04","type":"NDC"}],"standard_charges":[{"gross_charge":72.35,"discounted_cash":43.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0043-04","type":"NDC"}],"standard_charges":[{"gross_charge":69.84,"discounted_cash":41.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0049-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.05,"discounted_cash":32.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MANNITOL 20 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0357-03","type":"NDC"}],"standard_charges":[{"gross_charge":168.86,"discounted_cash":101.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0049-02","type":"NDC"}],"standard_charges":[{"gross_charge":61.94,"discounted_cash":37.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0049-04","type":"NDC"}],"standard_charges":[{"gross_charge":64.65,"discounted_cash":38.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0049-41","type":"NDC"}],"standard_charges":[{"gross_charge":57.05,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":57.39,"discounted_cash":34.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0049-48","type":"NDC"}],"standard_charges":[{"gross_charge":58.23,"discounted_cash":34.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":58.43,"discounted_cash":35.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0066-20","type":"NDC"}],"standard_charges":[{"gross_charge":67.6,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0070-10","type":"NDC"}],"standard_charges":[{"gross_charge":70.05,"discounted_cash":42.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.2 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0077-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.6,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0085-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.42,"discounted_cash":40.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE-NACL 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0089-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.2,"discounted_cash":39.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":33.58,"discounted_cash":20.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0117-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.34,"discounted_cash":37.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0117-04","type":"NDC"}],"standard_charges":[{"gross_charge":64.36,"discounted_cash":38.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0338-0049-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.10,"discounted_cash":37.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIANEAL LOW CALCIUM/2.5% DEX 395 MOSM/L IP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0941-0457-01","type":"NDC"}],"standard_charges":[{"gross_charge":252.23,"discounted_cash":151.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EXTRANEAL 7.5 % IP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0941-0679-05","type":"NDC"}],"standard_charges":[{"gross_charge":489.27,"discounted_cash":293.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0990-7075-26","type":"NDC"}],"standard_charges":[{"gross_charge":6.52,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1315-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1315-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1315-35","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1316-35","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1316-37","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1316-41","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1316-52","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1412-15","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0407-1413-58","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-5264-16","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1111-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1111-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1111-03","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-0351-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1111-04","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1111-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1111-03","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1111-04","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1111-45","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1111-70","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-5164-14","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-5164-15","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-5164-14","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-5164-15","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0634","type":"RC"},{"code":"0069-1307-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.06,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":36.91,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0634","type":"RC"},{"code":"0069-1307-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":36.87,"discounted_cash":22.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1307-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.62,"discounted_cash":23.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1111-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1412-15","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1316-52","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1316-41","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0990-7111-09","type":"NDC"}],"standard_charges":[{"gross_charge":84.7,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0990-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.2,"discounted_cash":39.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":64.30,"discounted_cash":38.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"63323-093-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.05,"discounted_cash":26.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"63323-624-06","type":"NDC"}],"standard_charges":[{"gross_charge":56.65,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"63323-870-74","type":"NDC"}],"standard_charges":[{"gross_charge":31.38,"discounted_cash":18.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"65219-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":77.4,"discounted_cash":46.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"65219-470-05","type":"NDC"}],"standard_charges":[{"gross_charge":60.16,"discounted_cash":36.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"65219-474-05","type":"NDC"}],"standard_charges":[{"gross_charge":62.37,"discounted_cash":37.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"65219-533-25","type":"NDC"}],"standard_charges":[{"gross_charge":179.3,"discounted_cash":107.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"Maci: 1 Bag In 1 Box (69866-1030-5)  / 1 Bottle, Plastic In 1 Bag (69866-1030-4)  / 1 Implant In 1 Bottle, Plastic (69866-1030-3)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69866-1030-5","type":"NDC"}],"standard_charges":[{"gross_charge":260859.5,"discounted_cash":156515.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FDG PER DOSE,UP TO 45 MCI","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76419-111-50","type":"NDC"}],"standard_charges":[{"gross_charge":1568.0,"discounted_cash":940.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TECHNET TC 99M SULFUR COLLOID CO KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0255","type":"RC"},{"code":"45567-0030-1","type":"NDC"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE 30 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-0149-57","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE 18 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1410-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE 30 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-0149-57","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE 18 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1410-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1316-37","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1316-35","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1315-35","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1315-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1315-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 41 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1411-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 41 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1411-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 41 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1411-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 41 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-1314-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-0445-40","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0019-4816-04","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-0445-40","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0019-4816-04","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IOPAMIDOL 51 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1317-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0258","type":"RC"},{"code":"0264-7750-00","type":"NDC"}],"standard_charges":[{"gross_charge":60.3,"discounted_cash":36.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMETELSTAT SODIUM 47 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"82959-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":29951.5,"discounted_cash":17970.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMETELSTAT SODIUM 188 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"82959-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":79870.65,"discounted_cash":47922.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CELECOXIB 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72241-023-05","type":"NDC"}],"standard_charges":[{"gross_charge":15.9,"discounted_cash":9.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CELECOXIB 200 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72241-024-05","type":"NDC"}],"standard_charges":[{"gross_charge":22.17,"discounted_cash":13.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYBURIDE 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72241-039-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYBURIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72241-040-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72266-197-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.55,"discounted_cash":40.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72485-510-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.9,"discounted_cash":25.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72485-625-13","type":"NDC"}],"standard_charges":[{"gross_charge":399.1,"discounted_cash":239.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72485-670-31","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72578-089-04","type":"NDC"}],"standard_charges":[{"gross_charge":88.55,"discounted_cash":53.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-004-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.78,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-009-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.65,"discounted_cash":4.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-024-06","type":"NDC"}],"standard_charges":[{"gross_charge":28.08,"discounted_cash":16.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72241-011-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.67,"discounted_cash":7.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE ER 10 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-031-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOLAZONE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-053-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.46,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-104-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.57,"discounted_cash":6.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-125-26","type":"NDC"}],"standard_charges":[{"gross_charge":12.66,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.85,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM 8 MEQ/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-172-46","type":"NDC"}],"standard_charges":[{"gross_charge":21.3,"discounted_cash":12.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-208-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"73293-0001-1","type":"NDC"}],"standard_charges":[{"gross_charge":25.27,"discounted_cash":15.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"73480-150-04","type":"NDC"}],"standard_charges":[{"gross_charge":189.7,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDOMETHACIN 100 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"73702-140-71","type":"NDC"}],"standard_charges":[{"gross_charge":1103.1,"discounted_cash":661.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENAZOPYRIDINE HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75826-115-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL 32.4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75826-139-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.26,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL ER 180 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75834-158-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.41,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL ER 240 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75834-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOLAZONE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72888-052-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROFLUMILAST 500 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-200-30","type":"NDC"}],"standard_charges":[{"gross_charge":34.9,"discounted_cash":20.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBENDAZOLE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-051-08","type":"NDC"}],"standard_charges":[{"gross_charge":561.08,"discounted_cash":336.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-044-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.40,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-5100-1","type":"NDC"}],"standard_charges":[{"gross_charge":110.96,"discounted_cash":66.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-5103-1","type":"NDC"}],"standard_charges":[{"gross_charge":109.37,"discounted_cash":65.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-9011-1","type":"NDC"}],"standard_charges":[{"gross_charge":40.66,"discounted_cash":24.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 50 MG/5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-9080-2","type":"NDC"}],"standard_charges":[{"gross_charge":40.49,"discounted_cash":24.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 50 MG/5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-9080-4","type":"NDC"}],"standard_charges":[{"gross_charge":39.29,"discounted_cash":23.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARDIOPLEGIA DEL NIDO FORMULA PF SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71285-0202-1","type":"NDC"}],"standard_charges":[{"gross_charge":231.05,"discounted_cash":138.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-202-02","type":"NDC"}],"standard_charges":[{"gross_charge":115.25,"discounted_cash":69.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-505-02","type":"NDC"}],"standard_charges":[{"gross_charge":22.72,"discounted_cash":13.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-505-03","type":"NDC"}],"standard_charges":[{"gross_charge":22.79,"discounted_cash":13.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-700-05","type":"NDC"}],"standard_charges":[{"gross_charge":21.78,"discounted_cash":13.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":27.89,"discounted_cash":16.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROCURONIUM BROMIDE 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-700-06","type":"NDC"}],"standard_charges":[{"gross_charge":35.18,"discounted_cash":21.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-713-20","type":"NDC"}],"standard_charges":[{"gross_charge":308.56,"discounted_cash":185.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-714-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.42,"discounted_cash":20.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-718-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.6,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES 280-160-250 MG PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71351-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.19,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.86,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOFETILIDE 500 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-041-60","type":"NDC"}],"standard_charges":[{"gross_charge":28.45,"discounted_cash":17.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOFETILIDE 250 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-040-60","type":"NDC"}],"standard_charges":[{"gross_charge":27.56,"discounted_cash":16.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOFETILIDE 125 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-039-60","type":"NDC"}],"standard_charges":[{"gross_charge":28.45,"discounted_cash":17.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-011-90","type":"NDC"}],"standard_charges":[{"gross_charge":23.11,"discounted_cash":13.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72196-6044-1","type":"NDC"}],"standard_charges":[{"gross_charge":78.43,"discounted_cash":47.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CENOBAMATE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71699-200-30","type":"NDC"}],"standard_charges":[{"gross_charge":118.32,"discounted_cash":70.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN BASE 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75834-242-30","type":"NDC"}],"standard_charges":[{"gross_charge":33.92,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES 8.6 MG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71399-8245-3","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.62,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71399-8014-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71399-7889-1","type":"NDC"}],"standard_charges":[{"gross_charge":14.15,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71399-4456-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.10,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMINS A & D EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71399-0122-4","type":"NDC"}],"standard_charges":[{"gross_charge":31.6,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES 280-160-250 MG PO PACK WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71351-010-99","type":"NDC"}],"standard_charges":[{"gross_charge":4.91,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.88,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-7510-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75834-280-30","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75907-023-48","type":"NDC"}],"standard_charges":[{"gross_charge":85.6,"discounted_cash":51.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MOMETASONE FUROATE 200 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"78206-113-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.42,"discounted_cash":5.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"79854-200-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN E 400 UNITS PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"79854-90020","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM HYALURONATE 8.5 MG/0.85ML IO SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"8065-183085","type":"NDC"}],"standard_charges":[{"gross_charge":725.56,"discounted_cash":435.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA CHONDROIT SULF-NA HYALURON 20-15 MG/0.5ML IO SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"8065-183905","type":"NDC"}],"standard_charges":[{"gross_charge":591.16,"discounted_cash":354.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHILDRENS CHEWABLE VITAMINS PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"80681-04900","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"80681-09800","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.70,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EUCERIN EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"80681-15500","type":"NDC"}],"standard_charges":[{"gross_charge":29.1,"discounted_cash":17.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":17.32,"discounted_cash":10.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN D3 25 MCG (1000 UT) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"80681-16900","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WHITE PETROLATUM EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"8080-430101","type":"NDC"}],"standard_charges":[{"gross_charge":24.7,"discounted_cash":14.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MOMETASONE FUROATE 100 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"78206-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"81298-5010-1","type":"NDC"}],"standard_charges":[{"gross_charge":460.9,"discounted_cash":276.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN 500 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"81964-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"81964-221-14","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":10.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"82182-106-14","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"82293-003-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"82293-004-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXEGOL OXALATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"82625-8802-1","type":"NDC"}],"standard_charges":[{"gross_charge":46.37,"discounted_cash":27.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN GLARGINE-YFGN 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"83257-015-31","type":"NDC"}],"standard_charges":[{"gross_charge":81.3,"discounted_cash":48.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"87701-40072","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"87701-40729","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN E 90 MG (200 UNIT) PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"87701-40753","type":"NDC"}],"standard_charges":[{"gross_charge":4.07,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FISH OIL 1000 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"87701-40818","type":"NDC"}],"standard_charges":[{"gross_charge":4.27,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.32,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCOSANOL 10 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"87701-43380","type":"NDC"}],"standard_charges":[{"gross_charge":73.35,"discounted_cash":44.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCROSE 24% PO SOLUTION","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"89805-60340","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"81298-5010-5","type":"NDC"}],"standard_charges":[{"gross_charge":460.9,"discounted_cash":276.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYVINYL ALCOHOL-POVIDONE 5-6 MG/ML OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"78112-73645","type":"NDC"}],"standard_charges":[{"gross_charge":38.35,"discounted_cash":23.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZOCAINE-MENTHOL 6-10 MG MT LOZG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"78112-01106","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZINC SULFATE 220 (50 ZN) MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-983-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75907-024-48","type":"NDC"}],"standard_charges":[{"gross_charge":140.95,"discounted_cash":84.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.3 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75907-025-48","type":"NDC"}],"standard_charges":[{"gross_charge":193.7,"discounted_cash":116.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORTRIPTYLINE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75907-069-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORTRIPTYLINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75907-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.52,"discounted_cash":3.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76204-022-60","type":"NDC"}],"standard_charges":[{"gross_charge":6.70,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76204-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76204-200-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76204-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":6.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76204-800-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76204-900-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-3012-5","type":"NDC"}],"standard_charges":[{"gross_charge":22.65,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-3302-1","type":"NDC"}],"standard_charges":[{"gross_charge":91.47,"discounted_cash":54.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-3304-1","type":"NDC"}],"standard_charges":[{"gross_charge":54.78,"discounted_cash":32.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-3352-1","type":"NDC"}],"standard_charges":[{"gross_charge":68.43,"discounted_cash":41.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 4 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76329-6300-5","type":"NDC"}],"standard_charges":[{"gross_charge":93.18,"discounted_cash":55.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOLAZONE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76385-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":6.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN E 180 MG (400 UNIT) PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-951-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-6 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-940-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.12,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.82,"discounted_cash":1.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-12 1000 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-938-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.66,"discounted_cash":1.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL ER 120 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75834-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-844-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.00,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMETHICONE 80 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-812-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.00,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FISH OIL 1000 MG PO CAPS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-308-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.91,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FISH OIL 1000 MG PO CAPS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-308-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOLAZONE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76385-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.14,"discounted_cash":6.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-835-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OLANZAPINE 10 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3159-72","type":"NDC"}],"standard_charges":[{"gross_charge":7.39,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-7510-17","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":10.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-7737-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.73,"discounted_cash":10.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4031-16","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4264-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.40,"discounted_cash":20.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.40,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4264-11","type":"NDC"}],"standard_charges":[{"gross_charge":33.60,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.14,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4276-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":20.15,"discounted_cash":12.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4277-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":30.95,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4279-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":33.80,"discounted_cash":20.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4279-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":31.54,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4282-12","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":29.44,"discounted_cash":17.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4283-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.20,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":30.56,"discounted_cash":18.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4283-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.20,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":39.6,"discounted_cash":23.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4444-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.97,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4688-16","type":"NDC"}],"standard_charges":[{"gross_charge":35.78,"discounted_cash":21.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4031-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.93,"discounted_cash":23.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4688-22","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4755-18","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4776-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":32.5,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-5922-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.55,"discounted_cash":18.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-6482-01","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":96.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-6482-11","type":"NDC"}],"standard_charges":[{"gross_charge":257.02,"discounted_cash":154.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9094-12","type":"NDC"}],"standard_charges":[{"gross_charge":29.94,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9094-22","type":"NDC"}],"standard_charges":[{"gross_charge":30.59,"discounted_cash":18.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9094-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.21,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9094-41","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9104-21","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9158-31","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":10.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9158-50","type":"NDC"}],"standard_charges":[{"gross_charge":13.50,"discounted_cash":8.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0456-0600-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.92,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0456-0600-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.10,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4699-54","type":"NDC"}],"standard_charges":[{"gross_charge":0.91,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0456-2700-01","type":"NDC"}],"standard_charges":[{"gross_charge":279.99,"discounted_cash":168.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3815-12","type":"NDC"}],"standard_charges":[{"gross_charge":87.38,"discounted_cash":52.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3414-18","type":"NDC"}],"standard_charges":[{"gross_charge":29.27,"discounted_cash":17.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-9541-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-9543-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.8,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.61,"discounted_cash":21.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-0183-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.72,"discounted_cash":22.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1163-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1176-03","type":"NDC"}],"standard_charges":[{"gross_charge":36.77,"discounted_cash":22.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1273-03","type":"NDC"}],"standard_charges":[{"gross_charge":75.45,"discounted_cash":45.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1273-32","type":"NDC"}],"standard_charges":[{"gross_charge":75.45,"discounted_cash":45.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1283-03","type":"NDC"}],"standard_charges":[{"gross_charge":31.69,"discounted_cash":19.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.05,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1283-17","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1283-31","type":"NDC"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":19.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.30,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1391-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3414-21","type":"NDC"}],"standard_charges":[{"gross_charge":29.14,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1391-22","type":"NDC"}],"standard_charges":[{"gross_charge":7.50,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1886-15","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1886-22","type":"NDC"}],"standard_charges":[{"gross_charge":0.58,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1890-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.88,"discounted_cash":19.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1890-03","type":"NDC"}],"standard_charges":[{"gross_charge":32.06,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2634-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.33,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2634-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2720-31","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":9.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3150-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3150-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3164-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3178-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3365-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.62,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3414-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.93,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1886-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.53,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0456-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":293.6,"discounted_cash":176.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-0650-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-1001-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.91,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6059-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.69,"discounted_cash":5.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.41,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6063-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6125-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.23,"discounted_cash":18.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6125-25","type":"NDC"}],"standard_charges":[{"gross_charge":31.43,"discounted_cash":18.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6127-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.22,"discounted_cash":18.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6127-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.45,"discounted_cash":17.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6146-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.87,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6146-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.82,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6175-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.40,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6182-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.06,"discounted_cash":25.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6182-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.1,"discounted_cash":28.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6188-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6205-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.43,"discounted_cash":41.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6205-10","type":"NDC"}],"standard_charges":[{"gross_charge":60.63,"discounted_cash":36.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.60,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6207-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.14,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6207-25","type":"NDC"}],"standard_charges":[{"gross_charge":27.56,"discounted_cash":16.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6209-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.7,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6210-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.06,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6210-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6228-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":16.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6228-25","type":"NDC"}],"standard_charges":[{"gross_charge":22.70,"discounted_cash":13.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6253-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.81,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0703-0113-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.21,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.14,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0703-4239-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.26,"discounted_cash":13.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6057-25","type":"NDC"}],"standard_charges":[{"gross_charge":13.95,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6057-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.83,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-1020-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-1820-01","type":"NDC"}],"standard_charges":[{"gross_charge":373.21,"discounted_cash":223.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-2310-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-2340-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-2340-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-2340-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-4601-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.68,"discounted_cash":16.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-4810-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.30,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.55,"discounted_cash":18.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-9702-25","type":"NDC"}],"standard_charges":[{"gross_charge":32.75,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0548-5850-00","type":"NDC"}],"standard_charges":[{"gross_charge":832.04,"discounted_cash":499.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COSYNTROPIN 0.25 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0548-5900-00","type":"NDC"}],"standard_charges":[{"gross_charge":339.6,"discounted_cash":203.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0548-5905-00","type":"NDC"}],"standard_charges":[{"gross_charge":836.6,"discounted_cash":501.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0572-35","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0603-5336-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-0367-21","type":"NDC"}],"standard_charges":[{"gross_charge":3.03,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.49,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6053-25","type":"NDC"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":19.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6053-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.53,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6052-25","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6044-25","type":"NDC"}],"standard_charges":[{"gross_charge":28.10,"discounted_cash":16.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6027-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.97,"discounted_cash":17.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6007-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.29,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-9159-30","type":"NDC"}],"standard_charges":[{"gross_charge":71.52,"discounted_cash":42.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6007-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-1410-35","type":"NDC"}],"standard_charges":[{"gross_charge":34.94,"discounted_cash":20.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-1410-31","type":"NDC"}],"standard_charges":[{"gross_charge":33.82,"discounted_cash":20.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-1397-31","type":"NDC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-0376-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":17.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-0376-21","type":"NDC"}],"standard_charges":[{"gross_charge":28.52,"discounted_cash":17.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-0367-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6001-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.61,"discounted_cash":17.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-6046-48","type":"NDC"}],"standard_charges":[{"gross_charge":105.2,"discounted_cash":63.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-6045-37","type":"NDC"}],"standard_charges":[{"gross_charge":55.78,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-4114-50","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":17.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0024-5926-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.44,"discounted_cash":11.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0049-0014-81","type":"NDC"}],"standard_charges":[{"gross_charge":35.02,"discounted_cash":21.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0018-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.16,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0019-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 1 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-3176-44","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-4550-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.16,"discounted_cash":5.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8174-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8175-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8176-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8740-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.61,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-PVVR 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-0238-01","type":"NDC"}],"standard_charges":[{"gross_charge":211.34,"discounted_cash":126.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-0248-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.91,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-PVVR 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-0249-01","type":"NDC"}],"standard_charges":[{"gross_charge":210.51,"discounted_cash":126.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0024-5924-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.8,"discounted_cash":16.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FILGRASTIM-AAFI 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-0291-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-1305-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.41,"discounted_cash":27.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-1305-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-1308-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.88,"discounted_cash":20.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-1308-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.80,"discounted_cash":20.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-1309-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.99,"discounted_cash":19.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-1311-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.76,"discounted_cash":20.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-1311-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.68,"discounted_cash":20.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-3034-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-7334-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.03,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-9018-19","type":"NDC"}],"standard_charges":[{"gross_charge":5.14,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-9020-19","type":"NDC"}],"standard_charges":[{"gross_charge":18.05,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9098-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOBUTAMINE HCL 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9141-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9161-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.38,"discounted_cash":21.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-0292-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.20,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RASBURICASE 1.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0024-5150-10","type":"NDC"}],"standard_charges":[{"gross_charge":1056.77,"discounted_cash":634.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0024-2792-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.15,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0024-2792-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.46,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 10 UNITS/0.1 ML FOR IV PUSH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8215-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.20,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":15.34,"discounted_cash":9.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO (1 UNIT DIAL) 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8222-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.61,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO (1 UNIT DIAL) 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8222-59","type":"NDC"}],"standard_charges":[{"gross_charge":13.40,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8315-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.27,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8715-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO (1 UNIT DIAL) 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8799-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.19,"discounted_cash":12.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0005-2000-02","type":"NDC"}],"standard_charges":[{"gross_charge":779.25,"discounted_cash":467.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0005-2000-10","type":"NDC"}],"standard_charges":[{"gross_charge":812.35,"discounted_cash":487.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0008-0923-51","type":"NDC"}],"standard_charges":[{"gross_charge":39.74,"discounted_cash":23.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0008-0923-55","type":"NDC"}],"standard_charges":[{"gross_charge":34.03,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0008-0923-60","type":"NDC"}],"standard_charges":[{"gross_charge":39.47,"discounted_cash":23.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0008-4001-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.96,"discounted_cash":22.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIGECYCLINE 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0008-4990-19","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":3.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIGECYCLINE 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0008-4990-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0011-03","type":"NDC"}],"standard_charges":[{"gross_charge":61.42,"discounted_cash":36.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0011-04","type":"NDC"}],"standard_charges":[{"gross_charge":61.58,"discounted_cash":36.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON DEXTRAN 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0023-6082-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.13,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON DEXTRAN 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0023-6082-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.58,"discounted_cash":30.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONABOTULINUMTOXINA 100 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0023-1145-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.02,"discounted_cash":11.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-7807-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.07,"discounted_cash":29.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-5140-04","type":"NDC"}],"standard_charges":[{"gross_charge":49.07,"discounted_cash":29.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-5140-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.07,"discounted_cash":29.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0698-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0047-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.88,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0047-22","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0047-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0039-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.53,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0039-28","type":"NDC"}],"standard_charges":[{"gross_charge":5.46,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-0039-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-7533-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.67,"discounted_cash":10.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9161-25","type":"NDC"}],"standard_charges":[{"gross_charge":35.45,"discounted_cash":21.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.42,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9162-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.40,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.67,"discounted_cash":0.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0264-4100-90","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0264-7800-10","type":"NDC"}],"standard_charges":[{"gross_charge":60.3,"discounted_cash":36.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE IN D5W 8-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0264-9598-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFUR HEXAFLUORIDE MICROSPH 60.7-25 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-7097-07","type":"NDC"}],"standard_charges":[{"gross_charge":452.85,"discounted_cash":271.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFUR HEXAFLUORIDE MICROSPH 60.7-25 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0270-7099-16","type":"NDC"}],"standard_charges":[{"gross_charge":443.60,"discounted_cash":266.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DURVALUMAB 120 MG/2.4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-4500-12","type":"NDC"}],"standard_charges":[{"gross_charge":247.81,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DURVALUMAB 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-4611-50","type":"NDC"}],"standard_charges":[{"gross_charge":246.94,"discounted_cash":148.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0049-02","type":"NDC"}],"standard_charges":[{"gross_charge":62.54,"discounted_cash":37.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0049-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.58,"discounted_cash":37.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0049-04","type":"NDC"}],"standard_charges":[{"gross_charge":64.80,"discounted_cash":38.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0049-41","type":"NDC"}],"standard_charges":[{"gross_charge":57.79,"discounted_cash":34.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0049-48","type":"NDC"}],"standard_charges":[{"gross_charge":58.54,"discounted_cash":35.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0054-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9924-90","type":"NDC"}],"standard_charges":[{"gross_charge":8.83,"discounted_cash":5.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE IN D5W 8-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0411-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 2000-0.9 UNIT/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0433-04","type":"NDC"}],"standard_charges":[{"gross_charge":20.39,"discounted_cash":12.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0803-04","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1007-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.21,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1047-02","type":"NDC"}],"standard_charges":[{"gross_charge":52.80,"discounted_cash":31.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1049-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1055-48","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1075-02","type":"NDC"}],"standard_charges":[{"gross_charge":83.85,"discounted_cash":50.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1708-40","type":"NDC"}],"standard_charges":[{"gross_charge":21.86,"discounted_cash":13.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1709-40","type":"NDC"}],"standard_charges":[{"gross_charge":34.68,"discounted_cash":20.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL IN NACL 1-0.9 GM/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-3583-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.18,"discounted_cash":36.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-3612-24","type":"NDC"}],"standard_charges":[{"gross_charge":40.31,"discounted_cash":24.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-3612-50","type":"NDC"}],"standard_charges":[{"gross_charge":40.9,"discounted_cash":24.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-3814-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.66,"discounted_cash":17.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-3814-50","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":17.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9875-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9875-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9856-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9162-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.38,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9164-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.77,"discounted_cash":11.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9180-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9254-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":2.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9254-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9328-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9398-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.28,"discounted_cash":43.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9431-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9431-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.13,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9503-01","type":"NDC"}],"standard_charges":[{"gross_charge":104.63,"discounted_cash":62.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9512-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9514-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.67,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARGATROBAN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9559-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENTOLAMINE MESYLATE 5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9564-01","type":"NDC"}],"standard_charges":[{"gross_charge":1462.55,"discounted_cash":877.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9570-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.37,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9856-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9754-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9754-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9746-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.45,"discounted_cash":20.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9721-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":20.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9720-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.95,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9719-10","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9689-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":102.15,"discounted_cash":61.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9682-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9680-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9673-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.80,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9622-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9570-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.37,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9719-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE-NACL 2.5-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-5010-1","type":"NDC"}],"standard_charges":[{"gross_charge":128.11,"discounted_cash":76.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0047-22","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0698-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-162-00","type":"NDC"}],"standard_charges":[{"gross_charge":27.62,"discounted_cash":16.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.42,"discounted_cash":12.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-165-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-165-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.00,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-172-60","type":"NDC"}],"standard_charges":[{"gross_charge":34.17,"discounted_cash":20.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-173-02","type":"NDC"}],"standard_charges":[{"gross_charge":66.90,"discounted_cash":40.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOXINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-180-00","type":"NDC"}],"standard_charges":[{"gross_charge":83.27,"discounted_cash":49.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-229-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.00,"discounted_cash":8.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-229-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-229-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.98,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-265-30","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-269-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-269-78","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-273-01","type":"NDC"}],"standard_charges":[{"gross_charge":176.9,"discounted_cash":106.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BLEOMYCIN SULFATE 30 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-137-20","type":"NDC"}],"standard_charges":[{"gross_charge":154.12,"discounted_cash":92.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VINBLASTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-278-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.90,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-280-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.08,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.14,"discounted_cash":18.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-285-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-288-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.47,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPIVACAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-294-27","type":"NDC"}],"standard_charges":[{"gross_charge":29.55,"discounted_cash":17.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-314-61","type":"NDC"}],"standard_charges":[{"gross_charge":38.32,"discounted_cash":22.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":33.49,"discounted_cash":20.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-314-66","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GANCICLOVIR SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":275.15,"discounted_cash":165.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-325-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.78,"discounted_cash":0.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-325-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-325-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.77,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-325-14","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-325-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.76,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-341-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.05,"discounted_cash":27.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MITOXANTRONE HCL 20 MG/10ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-132-12","type":"NDC"}],"standard_charges":[{"gross_charge":424.82,"discounted_cash":254.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-064-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.06,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-064-41","type":"NDC"}],"standard_charges":[{"gross_charge":10.34,"discounted_cash":6.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISPLATIN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-103-64","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-104-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.03,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-104-50","type":"NDC"}],"standard_charges":[{"gross_charge":5.03,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-106-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-106-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.11,"discounted_cash":10.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.81,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.87,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.42,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MITOXANTRONE HCL 20 MG/10ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-132-10","type":"NDC"}],"standard_charges":[{"gross_charge":384.33,"discounted_cash":230.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-18","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.68,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-28","type":"NDC"}],"standard_charges":[{"gross_charge":11.22,"discounted_cash":6.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.54,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-41","type":"NDC"}],"standard_charges":[{"gross_charge":8.46,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.22,"discounted_cash":5.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-43","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.63,"discounted_cash":5.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-51","type":"NDC"}],"standard_charges":[{"gross_charge":11.31,"discounted_cash":6.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.97,"discounted_cash":5.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.43,"discounted_cash":6.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.98,"discounted_cash":5.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-117-68","type":"NDC"}],"standard_charges":[{"gross_charge":7.86,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.91,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-128-00","type":"NDC"}],"standard_charges":[{"gross_charge":23.72,"discounted_cash":14.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-128-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":14.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-341-41","type":"NDC"}],"standard_charges":[{"gross_charge":33.85,"discounted_cash":20.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-342-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.12,"discounted_cash":20.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-342-25","type":"NDC"}],"standard_charges":[{"gross_charge":34.20,"discounted_cash":20.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-489-17","type":"NDC"}],"standard_charges":[{"gross_charge":43.78,"discounted_cash":26.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.27,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-04","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-07","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-27","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-41","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-45","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-57","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-495-04","type":"NDC"}],"standard_charges":[{"gross_charge":0.27,"discounted_cash":0.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.24,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-495-07","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-506-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.99,"discounted_cash":4.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.54,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-508-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-516-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.31,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-518-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-518-77","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 25000-5 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-522-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-562-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-578-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.50,"discounted_cash":6.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":145.29,"discounted_cash":87.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-579-05","type":"NDC"}],"standard_charges":[{"gross_charge":152.05,"discounted_cash":91.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEFEROXAMINE MESYLATE 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-597-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.78,"discounted_cash":26.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEFEROXAMINE MESYLATE 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-599-30","type":"NDC"}],"standard_charges":[{"gross_charge":37.01,"discounted_cash":22.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-604-00","type":"NDC"}],"standard_charges":[{"gross_charge":48.23,"discounted_cash":28.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-488-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-487-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.25,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.24,"discounted_cash":0.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":66.95,"discounted_cash":40.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-360-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-360-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-360-61","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-377-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.79,"discounted_cash":5.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-400-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZTREONAM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.30,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-403-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.59,"discounted_cash":6.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-403-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.15,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAFFEINE CITRATE 60 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-407-03","type":"NDC"}],"standard_charges":[{"gross_charge":9.88,"discounted_cash":5.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-411-18","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-434-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-434-41","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-464-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.82,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-464-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.32,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-464-17","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-464-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-466-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-487-07","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.29,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-485-26","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-482-27","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.76,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-482-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-481-57","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-478-27","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-474-00","type":"NDC"}],"standard_charges":[{"gross_charge":37.13,"discounted_cash":22.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-466-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-466-17","type":"NDC"}],"standard_charges":[{"gross_charge":0.35,"discounted_cash":0.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-466-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-482-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.23,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-024-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.34,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN 4 MG/ML IV SOLN (STOCK BAG-PEDIATRIC)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-010-94","type":"NDC"}],"standard_charges":[{"gross_charge":29.17,"discounted_cash":17.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-010-03","type":"NDC"}],"standard_charges":[{"gross_charge":15.84,"discounted_cash":9.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLIXIMAB 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57894-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":342.80,"discounted_cash":205.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"USTEKINUMAB 130 MG/26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57894-054-27","type":"NDC"}],"standard_charges":[{"gross_charge":47.87,"discounted_cash":28.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GOLIMUMAB 50 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57894-350-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.25,"discounted_cash":70.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIVANTAMAB-VMJW 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57894-501-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.60,"discounted_cash":38.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57894-503-01","type":"NDC"}],"standard_charges":[{"gross_charge":166.96,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DALBAVANCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57970-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.21,"discounted_cash":31.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-810-01","type":"NDC"}],"standard_charges":[{"gross_charge":105.45,"discounted_cash":63.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-810-43","type":"NDC"}],"standard_charges":[{"gross_charge":111.42,"discounted_cash":66.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-820-43","type":"NDC"}],"standard_charges":[{"gross_charge":111.22,"discounted_cash":66.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":112.7,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-821-43","type":"NDC"}],"standard_charges":[{"gross_charge":233.23,"discounted_cash":139.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-828-03","type":"NDC"}],"standard_charges":[{"gross_charge":632.85,"discounted_cash":379.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEASLES, MUMPS & RUBELLA VAC SC SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-831-03","type":"NDC"}],"standard_charges":[{"gross_charge":299.01,"discounted_cash":179.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-842-05","type":"NDC"}],"standard_charges":[{"gross_charge":157.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57664-683-31","type":"NDC"}],"standard_charges":[{"gross_charge":80.32,"discounted_cash":48.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-842-34","type":"NDC"}],"standard_charges":[{"gross_charge":157.5,"discounted_cash":94.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-958-01","type":"NDC"}],"standard_charges":[{"gross_charge":383.73,"discounted_cash":230.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-959-01","type":"NDC"}],"standard_charges":[{"gross_charge":388.3,"discounted_cash":232.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THYROTROPIN ALFA 0.9 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58468-0030-2","type":"NDC"}],"standard_charges":[{"gross_charge":5899.63,"discounted_cash":3539.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RESLIZUMAB 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59310-610-31","type":"NDC"}],"standard_charges":[{"gross_charge":32.09,"discounted_cash":19.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERUMOXYTOL 510 MG/17ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59338-775-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.91,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LUSPATERCEPT-AAMT 25 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59572-711-01","type":"NDC"}],"standard_charges":[{"gross_charge":116.69,"discounted_cash":70.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LUSPATERCEPT-AAMT 75 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59572-775-01","type":"NDC"}],"standard_charges":[{"gross_charge":116.32,"discounted_cash":69.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59630-266-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.90,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59630-266-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59651-484-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59651-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.06,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59676-310-00","type":"NDC"}],"standard_charges":[{"gross_charge":80.68,"discounted_cash":48.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59676-320-00","type":"NDC"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":47.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59676-320-04","type":"NDC"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":47.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-842-52","type":"NDC"}],"standard_charges":[{"gross_charge":166.99,"discounted_cash":100.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON 4 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"57237-077-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.76,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEGARELIX ACETATE 80 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55566-8303-1","type":"NDC"}],"standard_charges":[{"gross_charge":18.23,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-998-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.89,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-168-30","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.6,"discounted_cash":35.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-194-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-233-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.00,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEMIN 350 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55292-702-54","type":"NDC"}],"standard_charges":[{"gross_charge":91.71,"discounted_cash":55.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEMIN 350 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55292-702-55","type":"NDC"}],"standard_charges":[{"gross_charge":90.68,"discounted_cash":54.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.36,"discounted_cash":14.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TARLATAMAB-DLLE 1 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-059-01","type":"NDC"}],"standard_charges":[{"gross_charge":4421.2,"discounted_cash":2652.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TARLATAMAB-DLLE 10 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-077-01","type":"NDC"}],"standard_charges":[{"gross_charge":4396.54,"discounted_cash":2637.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEGFILGRASTIM 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":1568.91,"discounted_cash":941.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":281.91,"discounted_cash":169.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-207-01","type":"NDC"}],"standard_charges":[{"gross_charge":281.91,"discounted_cash":169.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROMIPLOSTIM 250 MCG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":308.57,"discounted_cash":185.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":32.03,"discounted_cash":19.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-998-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.93,"discounted_cash":22.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANITUMUMAB 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-956-01","type":"NDC"}],"standard_charges":[{"gross_charge":517.23,"discounted_cash":310.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANITUMUMAB 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-954-01","type":"NDC"}],"standard_charges":[{"gross_charge":519.09,"discounted_cash":311.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-880-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.40,"discounted_cash":21.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DENOSUMAB 120 MG/1.7ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-730-01","type":"NDC"}],"standard_charges":[{"gross_charge":82.12,"discounted_cash":49.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DENOSUMAB 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-710-21","type":"NDC"}],"standard_charges":[{"gross_charge":90.44,"discounted_cash":54.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59676-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":78.97,"discounted_cash":47.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DENOSUMAB 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-710-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.57,"discounted_cash":53.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-ARRX 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":209.97,"discounted_cash":125.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROMIPLOSTIM 125 MCG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.33,"discounted_cash":19.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":308.26,"discounted_cash":184.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROMIPLOSTIM 500 MCG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-222-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.14,"discounted_cash":19.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":307.75,"discounted_cash":184.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-ARRX 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-326-01","type":"NDC"}],"standard_charges":[{"gross_charge":210.51,"discounted_cash":126.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-604-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.32,"discounted_cash":28.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE 16 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59746-003-14","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59746-171-06","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60793-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":87.67,"discounted_cash":52.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60793-700-10","type":"NDC"}],"standard_charges":[{"gross_charge":99.13,"discounted_cash":59.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60793-701-02","type":"NDC"}],"standard_charges":[{"gross_charge":79.22,"discounted_cash":47.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":76.73,"discounted_cash":46.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60793-701-10","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":45.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61314-318-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.77,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61314-326-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61314-326-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.74,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61703-309-06","type":"NDC"}],"standard_charges":[{"gross_charge":61.88,"discounted_cash":37.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61703-309-16","type":"NDC"}],"standard_charges":[{"gross_charge":31.06,"discounted_cash":18.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61703-339-56","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":11.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PACLITAXEL 30 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61703-342-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-773-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.68,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MITOXANTRONE HCL 20 MG/10ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61703-343-18","type":"NDC"}],"standard_charges":[{"gross_charge":162.68,"discounted_cash":97.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MITOXANTRONE HCL 25 MG/12.5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61703-343-65","type":"NDC"}],"standard_charges":[{"gross_charge":162.68,"discounted_cash":97.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61703-408-41","type":"NDC"}],"standard_charges":[{"gross_charge":7.42,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61755-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.87,"discounted_cash":53.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61958-2002-2","type":"NDC"}],"standard_charges":[{"gross_charge":219.7,"discounted_cash":131.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REMDESIVIR 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"61958-2901-2","type":"NDC"}],"standard_charges":[{"gross_charge":7.61,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62332-619-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.36,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOPROSTENOL SODIUM 0.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62756-059-40","type":"NDC"}],"standard_charges":[{"gross_charge":85.95,"discounted_cash":51.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOPROSTENOL SODIUM 1.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62756-060-40","type":"NDC"}],"standard_charges":[{"gross_charge":45.27,"discounted_cash":27.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERIBULIN MESYLATE 1 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62856-389-01","type":"NDC"}],"standard_charges":[{"gross_charge":569.70,"discounted_cash":341.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) 22.5 MG SC KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62935-227-10","type":"NDC"}],"standard_charges":[{"gross_charge":1332.22,"discounted_cash":799.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) 30 MG SC KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62935-306-40","type":"NDC"}],"standard_charges":[{"gross_charge":1329.94,"discounted_cash":797.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62935-461-50","type":"NDC"}],"standard_charges":[{"gross_charge":1327.65,"discounted_cash":796.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG SC KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"62935-756-80","type":"NDC"}],"standard_charges":[{"gross_charge":1350.5,"discounted_cash":810.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-010-02","type":"NDC"}],"standard_charges":[{"gross_charge":35.61,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-718-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-494-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-145-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60219-1705-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60219-2038-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60219-2039-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.42,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6120-6","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6128-0","type":"NDC"}],"standard_charges":[{"gross_charge":29.07,"discounted_cash":17.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6128-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.29,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6130-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.04,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6130-5","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6132-7","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":1.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6142-0","type":"NDC"}],"standard_charges":[{"gross_charge":9.93,"discounted_cash":5.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6142-5","type":"NDC"}],"standard_charges":[{"gross_charge":9.71,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 10 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6143-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/115ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6143-4","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":169.54,"discounted_cash":101.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6146-0","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6146-4","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6147-0","type":"NDC"}],"standard_charges":[{"gross_charge":31.48,"discounted_cash":18.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-134-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.40,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-122-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.93,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEFEROXAMINE MESYLATE 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6237-6","type":"NDC"}],"standard_charges":[{"gross_charge":37.01,"discounted_cash":22.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEFEROXAMINE MESYLATE 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6237-0","type":"NDC"}],"standard_charges":[{"gross_charge":37.01,"discounted_cash":22.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6193-1","type":"NDC"}],"standard_charges":[{"gross_charge":43.74,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6159-4","type":"NDC"}],"standard_charges":[{"gross_charge":20.15,"discounted_cash":12.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59746-113-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6159-0","type":"NDC"}],"standard_charges":[{"gross_charge":20.13,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6157-0","type":"NDC"}],"standard_charges":[{"gross_charge":23.10,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6152-4","type":"NDC"}],"standard_charges":[{"gross_charge":47.77,"discounted_cash":28.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6152-1","type":"NDC"}],"standard_charges":[{"gross_charge":46.48,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6148-4","type":"NDC"}],"standard_charges":[{"gross_charge":34.33,"discounted_cash":20.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6148-0","type":"NDC"}],"standard_charges":[{"gross_charge":34.88,"discounted_cash":20.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6147-4","type":"NDC"}],"standard_charges":[{"gross_charge":31.48,"discounted_cash":18.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-6157-4","type":"NDC"}],"standard_charges":[{"gross_charge":23.1,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-165-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-614-00","type":"NDC"}],"standard_charges":[{"gross_charge":46.66,"discounted_cash":28.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-616-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.29,"discounted_cash":3.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-203-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":27.34,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-203-04","type":"NDC"}],"standard_charges":[{"gross_charge":0.69,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":14.13,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-203-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-203-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.84,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-203-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.86,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-303-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.99,"discounted_cash":18.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-402-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.75,"discounted_cash":6.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-402-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.91,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.41,"discounted_cash":2.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-403-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-201-85","type":"NDC"}],"standard_charges":[{"gross_charge":21.49,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-403-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.97,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-410-84","type":"NDC"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":6.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-410-88","type":"NDC"}],"standard_charges":[{"gross_charge":8.53,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-411-82","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-422-95","type":"NDC"}],"standard_charges":[{"gross_charge":5.68,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-427-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.91,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-432-80","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-432-81","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-433-82","type":"NDC"}],"standard_charges":[{"gross_charge":8.71,"discounted_cash":5.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-433-83","type":"NDC"}],"standard_charges":[{"gross_charge":8.7,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-434-84","type":"NDC"}],"standard_charges":[{"gross_charge":9.80,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-434-85","type":"NDC"}],"standard_charges":[{"gross_charge":7.53,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-435-86","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-435-87","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-436-88","type":"NDC"}],"standard_charges":[{"gross_charge":6.47,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-404-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-436-89","type":"NDC"}],"standard_charges":[{"gross_charge":5.69,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEMETREXED DISODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-167-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-164-50","type":"NDC"}],"standard_charges":[{"gross_charge":27.90,"discounted_cash":16.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70594-076-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.26,"discounted_cash":4.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70594-076-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.41,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70594-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.37,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70710-1411-1","type":"NDC"}],"standard_charges":[{"gross_charge":9.57,"discounted_cash":5.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOMEPIZOLE 1 GM/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70710-1478-1","type":"NDC"}],"standard_charges":[{"gross_charge":44.12,"discounted_cash":26.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70710-1530-1","type":"NDC"}],"standard_charges":[{"gross_charge":890.71,"discounted_cash":534.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70710-1531-1","type":"NDC"}],"standard_charges":[{"gross_charge":1370.34,"discounted_cash":822.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GOSERELIN ACETATE 3.6 MG SC IMPL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70720-950-36","type":"NDC"}],"standard_charges":[{"gross_charge":4120.21,"discounted_cash":2472.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GOSERELIN ACETATE 10.8 MG SC IMPL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70720-951-30","type":"NDC"}],"standard_charges":[{"gross_charge":3834.28,"discounted_cash":2300.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70748-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70748-175-30","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70860-218-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.80,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70860-781-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.37,"discounted_cash":6.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEMETREXED DISODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-166-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70860-781-41","type":"NDC"}],"standard_charges":[{"gross_charge":13.38,"discounted_cash":8.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70954-404-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71266-2003-2","type":"NDC"}],"standard_charges":[{"gross_charge":8.88,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-016-15","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-026-75","type":"NDC"}],"standard_charges":[{"gross_charge":38.27,"discounted_cash":22.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.82,"discounted_cash":0.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-030-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-101-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-101-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.40,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BLEOMYCIN SULFATE 30 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-107-20","type":"NDC"}],"standard_charges":[{"gross_charge":134.75,"discounted_cash":80.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCETAXEL 160 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-144-16","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-149-95","type":"NDC"}],"standard_charges":[{"gross_charge":0.29,"discounted_cash":0.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 50 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-160-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.32,"discounted_cash":31.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-162-30","type":"NDC"}],"standard_charges":[{"gross_charge":23.13,"discounted_cash":13.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70860-781-43","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-437-91","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-437-92","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-438-93","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RABIES IMMUNE GLOBULIN 300 UNIT/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76125-150-03","type":"NDC"}],"standard_charges":[{"gross_charge":1096.06,"discounted_cash":657.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RABIES IMMUNE GLOBULIN 1500 UNIT/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76125-150-10","type":"NDC"}],"standard_charges":[{"gross_charge":999.62,"discounted_cash":599.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RABIES IMMUNE GLOBULIN 1500 UNIT/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76125-150-11","type":"NDC"}],"standard_charges":[{"gross_charge":999.76,"discounted_cash":599.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1002.36,"discounted_cash":601.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHYTONADIONE 1 MG/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76329-1240-1","type":"NDC"}],"standard_charges":[{"gross_charge":99.8,"discounted_cash":59.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76329-3318-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.40,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.97,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76329-3340-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76329-3369-1","type":"NDC"}],"standard_charges":[{"gross_charge":75.15,"discounted_cash":45.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76329-3390-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76329-8261-0","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"78206-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.33,"discounted_cash":11.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLIXIMAB-ABDA 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"78206-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":221.37,"discounted_cash":132.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLIXIMAB-ABDA 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"78206-162-99","type":"NDC"}],"standard_charges":[{"gross_charge":221.27,"discounted_cash":132.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RABIES IMMUNE GLOBULIN 300 UNIT/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76125-150-02","type":"NDC"}],"standard_charges":[{"gross_charge":1072.33,"discounted_cash":643.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"8290-306414","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"83257-003-11","type":"NDC"}],"standard_charges":[{"gross_charge":182.31,"discounted_cash":109.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"83257-004-12","type":"NDC"}],"standard_charges":[{"gross_charge":181.35,"discounted_cash":108.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"83257-005-41","type":"NDC"}],"standard_charges":[{"gross_charge":511.84,"discounted_cash":307.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 1 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0169-7201-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.31,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0169-7202-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.31,"discounted_cash":4.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0169-7205-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.28,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-705-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.73,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-705-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.72,"discounted_cash":9.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500-500 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68982-182-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1000-1000 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68982-182-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0562-7805-25","type":"NDC"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":226.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-631-02","type":"NDC"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":226.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-631-03","type":"NDC"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":226.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-631-20","type":"NDC"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":226.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARFILZOMIB 10 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76075-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.55,"discounted_cash":132.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARFILZOMIB 30 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76075-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.55,"discounted_cash":132.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARFILZOMIB 60 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76075-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.55,"discounted_cash":132.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-438-94","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-600-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.36,"discounted_cash":20.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-719-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.49,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-719-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-807-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-807-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.05,"discounted_cash":0.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71288-808-77","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VUTRISIRAN SODIUM 25 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71336-1003-1","type":"NDC"}],"standard_charges":[{"gross_charge":8827.27,"discounted_cash":5296.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"71839-111-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.76,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72205-054-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72205-266-07","type":"NDC"}],"standard_charges":[{"gross_charge":0.02,"discounted_cash":0.0096,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72266-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":9.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72266-163-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.86,"discounted_cash":10.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72266-163-06","type":"NDC"}],"standard_charges":[{"gross_charge":15.98,"discounted_cash":9.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72266-248-01","type":"NDC"}],"standard_charges":[{"gross_charge":168.13,"discounted_cash":100.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":188.82,"discounted_cash":113.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72266-248-05","type":"NDC"}],"standard_charges":[{"gross_charge":165.64,"discounted_cash":99.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":150.89,"discounted_cash":90.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"76045-009-96","type":"NDC"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"75907-190-07","type":"NDC"}],"standard_charges":[{"gross_charge":14.80,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIPTORELIN PAMOATE 11.25 MG IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"74676-5904-1","type":"NDC"}],"standard_charges":[{"gross_charge":3552.63,"discounted_cash":2131.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MARGETUXIMAB-CMKB 250 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"74527-022-03","type":"NDC"}],"standard_charges":[{"gross_charge":152.21,"discounted_cash":91.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERRIC DERISOMALTOSE(ONE DOSE) 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"73594-9310-1","type":"NDC"}],"standard_charges":[{"gross_charge":103.14,"discounted_cash":61.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"73293-0001-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70512-843-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.3,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"UBLITUXIMAB-XIIY 150 MG/6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"73150-150-06","type":"NDC"}],"standard_charges":[{"gross_charge":217.02,"discounted_cash":130.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72611-860-04","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72611-860-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TISLELIZUMAB-JSGR 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72579-121-01","type":"NDC"}],"standard_charges":[{"gross_charge":160.19,"discounted_cash":96.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72485-417-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.40,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72485-417-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.38,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRVETUXIMAB SORAVTANSINE-GYNX 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"72903-853-01","type":"NDC"}],"standard_charges":[{"gross_charge":268.00,"discounted_cash":160.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLUENZA VAC A&B SURF ANT ADJ 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70461-024-04","type":"NDC"}],"standard_charges":[{"gross_charge":241.9,"discounted_cash":145.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70436-147-80","type":"NDC"}],"standard_charges":[{"gross_charge":140.14,"discounted_cash":84.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPTIFIBATIDE 75 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70436-027-80","type":"NDC"}],"standard_charges":[{"gross_charge":78.12,"discounted_cash":46.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65219-572-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.09,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65219-572-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOCILIZUMAB-AAZG 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65219-590-04","type":"NDC"}],"standard_charges":[{"gross_charge":14.53,"discounted_cash":8.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOCILIZUMAB-AAZG 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65219-592-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.36,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOCILIZUMAB-AAZG 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65219-594-20","type":"NDC"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65250-266-09","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.47,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE LIPOSOME 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65250-266-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.89,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65597-406-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.04,"discounted_cash":50.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"66689-307-08","type":"NDC"}],"standard_charges":[{"gross_charge":28.56,"discounted_cash":17.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CETUXIMAB 100 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"66733-948-23","type":"NDC"}],"standard_charges":[{"gross_charge":237.00,"discounted_cash":142.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CETUXIMAB 100 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"66733-958-23","type":"NDC"}],"standard_charges":[{"gross_charge":237.21,"discounted_cash":142.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"66794-204-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65219-570-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.03,"discounted_cash":8.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"66794-219-63","type":"NDC"}],"standard_charges":[{"gross_charge":35.4,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPTINEZUMAB-JJMR 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67386-130-51","type":"NDC"}],"standard_charges":[{"gross_charge":55.58,"discounted_cash":33.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-182-00","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-218-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.83,"discounted_cash":17.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-220-00","type":"NDC"}],"standard_charges":[{"gross_charge":71.68,"discounted_cash":43.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-220-05","type":"NDC"}],"standard_charges":[{"gross_charge":71.68,"discounted_cash":43.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-339-00","type":"NDC"}],"standard_charges":[{"gross_charge":47.19,"discounted_cash":28.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUTILIDE FUMARATE 1 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-366-10","type":"NDC"}],"standard_charges":[{"gross_charge":937.6,"discounted_cash":562.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-420-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-423-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.26,"discounted_cash":4.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.55,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-423-12","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-426-00","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-426-12","type":"NDC"}],"standard_charges":[{"gross_charge":28.35,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-428-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.74,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.04,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"66993-730-51","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65162-691-79","type":"NDC"}],"standard_charges":[{"gross_charge":13.76,"discounted_cash":8.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VEDOLIZUMAB 300 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"64764-300-20","type":"NDC"}],"standard_charges":[{"gross_charge":87.46,"discounted_cash":52.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"C1 ESTERASE INHIBITOR (HUMAN) 500 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63833-825-02","type":"NDC"}],"standard_charges":[{"gross_charge":238.47,"discounted_cash":143.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-651-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.63,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.21,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-658-20","type":"NDC"}],"standard_charges":[{"gross_charge":729.84,"discounted_cash":437.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-664-41","type":"NDC"}],"standard_charges":[{"gross_charge":29.05,"discounted_cash":17.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-694-04","type":"NDC"}],"standard_charges":[{"gross_charge":28.61,"discounted_cash":17.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-694-22","type":"NDC"}],"standard_charges":[{"gross_charge":28.28,"discounted_cash":16.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-694-41","type":"NDC"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-696-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.65,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-711-00","type":"NDC"}],"standard_charges":[{"gross_charge":27.98,"discounted_cash":16.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-739-12","type":"NDC"}],"standard_charges":[{"gross_charge":0.37,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-806-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-806-13","type":"NDC"}],"standard_charges":[{"gross_charge":5.27,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-806-50","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-851-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-885-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.99,"discounted_cash":17.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63833-397-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.79,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63833-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63833-387-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63833-386-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENDAMUSTINE HCL 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63459-348-04","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-ABBS 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63459-104-50","type":"NDC"}],"standard_charges":[{"gross_charge":247.95,"discounted_cash":148.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":248.12,"discounted_cash":148.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-965-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-965-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-965-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.52,"discounted_cash":1.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-963-41","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-963-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-963-21","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-ABBS 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63459-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":247.88,"discounted_cash":148.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-614-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.04,"discounted_cash":39.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-433-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-473-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS ER 1 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68992-3010-3","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69097-708-31","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":15.53,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69097-708-96","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":15.97,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69918-899-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.61,"discounted_cash":33.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69918-899-10","type":"NDC"}],"standard_charges":[{"gross_charge":70.45,"discounted_cash":42.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69918-901-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.05,"discounted_cash":20.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IXABEPILONE 15 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70020-1910-1","type":"NDC"}],"standard_charges":[{"gross_charge":532.00,"discounted_cash":319.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IXABEPILONE 45 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70020-1911-1","type":"NDC"}],"standard_charges":[{"gross_charge":532.00,"discounted_cash":319.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70069-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.63,"discounted_cash":6.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70069-301-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70069-728-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.18,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70069-788-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68817-134-50","type":"NDC"}],"standard_charges":[{"gross_charge":63.84,"discounted_cash":38.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70069-788-04","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70114-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":1021.4,"discounted_cash":612.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1049-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1049-5","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":7.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1463-2","type":"NDC"}],"standard_charges":[{"gross_charge":151.52,"discounted_cash":90.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1573-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1573-5","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1574-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1574-5","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1719-1","type":"NDC"}],"standard_charges":[{"gross_charge":21.79,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BEVACIZUMAB-MALY 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1754-1","type":"NDC"}],"standard_charges":[{"gross_charge":290.34,"discounted_cash":174.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BEVACIZUMAB-MALY 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70121-1755-1","type":"NDC"}],"standard_charges":[{"gross_charge":290.34,"discounted_cash":174.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 312 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70257-051-51","type":"NDC"}],"standard_charges":[{"gross_charge":266.16,"discounted_cash":159.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70436-019-82","type":"NDC"}],"standard_charges":[{"gross_charge":68.99,"discounted_cash":41.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPTIFIBATIDE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70436-026-80","type":"NDC"}],"standard_charges":[{"gross_charge":99.75,"discounted_cash":59.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70114-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":1021.4,"discounted_cash":612.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LURBINECTEDIN 4 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68727-712-01","type":"NDC"}],"standard_charges":[{"gross_charge":811.11,"discounted_cash":486.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68516-5214-1","type":"NDC"}],"standard_charges":[{"gross_charge":161.36,"discounted_cash":96.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68462-622-10","type":"NDC"}],"standard_charges":[{"gross_charge":15.68,"discounted_cash":9.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-528-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.07,"discounted_cash":25.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-529-20","type":"NDC"}],"standard_charges":[{"gross_charge":34.03,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-530-35","type":"NDC"}],"standard_charges":[{"gross_charge":13.74,"discounted_cash":8.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-618-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.42,"discounted_cash":19.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPTIFIBATIDE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-629-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.81,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-658-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.89,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-675-02","type":"NDC"}],"standard_charges":[{"gross_charge":5403.80,"discounted_cash":3242.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-794-10","type":"NDC"}],"standard_charges":[{"gross_charge":74.55,"discounted_cash":44.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-855-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.33,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-855-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GRANISETRON HCL 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-863-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67919-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":487.85,"discounted_cash":292.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON 4 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68001-246-16","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68001-524-28","type":"NDC"}],"standard_charges":[{"gross_charge":41.89,"discounted_cash":25.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":45.64,"discounted_cash":27.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68001-524-29","type":"NDC"}],"standard_charges":[{"gross_charge":38.26,"discounted_cash":22.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":37.63,"discounted_cash":22.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68462-621-02","type":"NDC"}],"standard_charges":[{"gross_charge":34.91,"discounted_cash":20.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"APREPITANT 40 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68462-583-40","type":"NDC"}],"standard_charges":[{"gross_charge":34.12,"discounted_cash":20.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68462-469-40","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68382-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.99,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68084-918-95","type":"NDC"}],"standard_charges":[{"gross_charge":13.78,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68084-907-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.85,"discounted_cash":10.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-433-22","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68084-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.88,"discounted_cash":8.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZATHIOPRINE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68084-229-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.88,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68084-155-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE 16 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68001-559-69","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68001-557-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68001-524-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.3,"discounted_cash":25.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":31.42,"discounted_cash":18.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 0.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"68084-449-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.23,"discounted_cash":7.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0047-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-164-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-154-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.64,"discounted_cash":0.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1886-22","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1890-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.19,"discounted_cash":19.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1890-03","type":"NDC"}],"standard_charges":[{"gross_charge":31.62,"discounted_cash":18.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-2585-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-2634-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.34,"discounted_cash":0.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-2634-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-2720-31","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3150-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3150-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3164-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3164-12","type":"NDC"}],"standard_charges":[{"gross_charge":0.94,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3178-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3178-17","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3365-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.25,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.61,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1886-15","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3414-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.37,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3414-18","type":"NDC"}],"standard_charges":[{"gross_charge":29.35,"discounted_cash":17.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3414-21","type":"NDC"}],"standard_charges":[{"gross_charge":29.49,"discounted_cash":17.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3815-12","type":"NDC"}],"standard_charges":[{"gross_charge":69.38,"discounted_cash":41.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4031-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.90,"discounted_cash":21.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4031-16","type":"NDC"}],"standard_charges":[{"gross_charge":22.77,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4264-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.45,"discounted_cash":20.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.93,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4264-11","type":"NDC"}],"standard_charges":[{"gross_charge":33.62,"discounted_cash":20.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.31,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4276-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.17,"discounted_cash":0.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4277-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.10,"discounted_cash":0.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4279-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.12,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4279-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.13,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3365-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.95,"discounted_cash":17.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4282-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1886-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALBUPHINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1463-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.65,"discounted_cash":23.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 300 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-3410-24","type":"NDC"}],"standard_charges":[{"gross_charge":25.4,"discounted_cash":15.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 300 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-3410-50","type":"NDC"}],"standard_charges":[{"gross_charge":25.4,"discounted_cash":15.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-3612-24","type":"NDC"}],"standard_charges":[{"gross_charge":40.59,"discounted_cash":24.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-3612-50","type":"NDC"}],"standard_charges":[{"gross_charge":40.9,"discounted_cash":24.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-3814-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.61,"discounted_cash":17.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-3814-50","type":"NDC"}],"standard_charges":[{"gross_charge":29.63,"discounted_cash":17.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-4114-50","type":"NDC"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":17.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-6045-37","type":"NDC"}],"standard_charges":[{"gross_charge":55.78,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-6046-48","type":"NDC"}],"standard_charges":[{"gross_charge":105.2,"discounted_cash":63.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-9159-30","type":"NDC"}],"standard_charges":[{"gross_charge":71.49,"discounted_cash":42.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-9541-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-9543-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.8,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-9543-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.6,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.55,"discounted_cash":21.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALBUPHINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1463-71","type":"NDC"}],"standard_charges":[{"gross_charge":35.36,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-0183-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.56,"discounted_cash":22.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1159-19","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1163-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.11,"discounted_cash":0.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1176-03","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":23.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1176-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.65,"discounted_cash":25.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1273-03","type":"NDC"}],"standard_charges":[{"gross_charge":74.95,"discounted_cash":44.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1273-32","type":"NDC"}],"standard_charges":[{"gross_charge":73.28,"discounted_cash":43.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1283-03","type":"NDC"}],"standard_charges":[{"gross_charge":31.81,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.19,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1283-17","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1283-31","type":"NDC"}],"standard_charges":[{"gross_charge":32.57,"discounted_cash":19.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.29,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1283-37","type":"NDC"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1391-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.53,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1391-22","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCETAXEL 160 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-0201-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.71,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4282-12","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4283-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4283-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-4300-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.22,"discounted_cash":39.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-4601-25","type":"NDC"}],"standard_charges":[{"gross_charge":33.52,"discounted_cash":20.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-4810-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.30,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.81,"discounted_cash":20.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-9702-25","type":"NDC"}],"standard_charges":[{"gross_charge":39.08,"discounted_cash":23.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0548-5850-00","type":"NDC"}],"standard_charges":[{"gross_charge":761.54,"discounted_cash":456.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COSYNTROPIN 0.25 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0548-5900-00","type":"NDC"}],"standard_charges":[{"gross_charge":339.11,"discounted_cash":203.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0548-5905-00","type":"NDC"}],"standard_charges":[{"gross_charge":844.51,"discounted_cash":506.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0555-0572-35","type":"NDC"}],"standard_charges":[{"gross_charge":10.50,"discounted_cash":6.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0574-0805-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.63,"discounted_cash":5.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0603-5336-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-0367-21","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-0367-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-0376-21","type":"NDC"}],"standard_charges":[{"gross_charge":28.47,"discounted_cash":17.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-0376-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.60,"discounted_cash":17.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-1397-31","type":"NDC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-1398-31","type":"NDC"}],"standard_charges":[{"gross_charge":75.85,"discounted_cash":45.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-1410-31","type":"NDC"}],"standard_charges":[{"gross_charge":34.82,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-1410-35","type":"NDC"}],"standard_charges":[{"gross_charge":39.02,"discounted_cash":23.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6001-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.83,"discounted_cash":17.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6007-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6027-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.61,"discounted_cash":17.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6044-25","type":"NDC"}],"standard_charges":[{"gross_charge":27.01,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6052-25","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6053-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6053-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.66,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6057-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":6.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":14.35,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6057-25","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-2340-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-2340-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":1.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-2340-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4444-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.83,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4688-16","type":"NDC"}],"standard_charges":[{"gross_charge":35.78,"discounted_cash":21.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4688-18","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4688-22","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4699-54","type":"NDC"}],"standard_charges":[{"gross_charge":0.91,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-4755-18","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-5922-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.88,"discounted_cash":19.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-6482-01","type":"NDC"}],"standard_charges":[{"gross_charge":160.5,"discounted_cash":96.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-6482-11","type":"NDC"}],"standard_charges":[{"gross_charge":161.83,"discounted_cash":97.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE PF 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-7241-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-9094-12","type":"NDC"}],"standard_charges":[{"gross_charge":29.64,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-9094-22","type":"NDC"}],"standard_charges":[{"gross_charge":30.19,"discounted_cash":18.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-9094-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.90,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-9094-41","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-9158-31","type":"NDC"}],"standard_charges":[{"gross_charge":17.63,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-9158-50","type":"NDC"}],"standard_charges":[{"gross_charge":13.50,"discounted_cash":8.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0456-0600-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.00,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-2310-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-1820-01","type":"NDC"}],"standard_charges":[{"gross_charge":352.87,"discounted_cash":211.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-1020-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-1001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-0799-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.99,"discounted_cash":10.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-0740-20","type":"NDC"}],"standard_charges":[{"gross_charge":117.68,"discounted_cash":70.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1709-40","type":"NDC"}],"standard_charges":[{"gross_charge":34.61,"discounted_cash":20.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-0740-01","type":"NDC"}],"standard_charges":[{"gross_charge":116.94,"discounted_cash":70.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-0650-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLBETUXIMAB-CLZB 300 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0469-4425-30","type":"NDC"}],"standard_charges":[{"gross_charge":46.91,"discounted_cash":28.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLBETUXIMAB-CLZB 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0469-3425-10","type":"NDC"}],"standard_charges":[{"gross_charge":93.81,"discounted_cash":56.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0456-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":308.79,"discounted_cash":185.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0456-2700-01","type":"NDC"}],"standard_charges":[{"gross_charge":283.03,"discounted_cash":169.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0456-0600-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-0720-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.14,"discounted_cash":15.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1708-40","type":"NDC"}],"standard_charges":[{"gross_charge":21.84,"discounted_cash":13.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1075-02","type":"NDC"}],"standard_charges":[{"gross_charge":83.66,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1055-48","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0292-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.20,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRASTUZUMAB-QYYP 420 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0305-01","type":"NDC"}],"standard_charges":[{"gross_charge":322.38,"discounted_cash":193.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRASTUZUMAB-QYYP 420 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0306-01","type":"NDC"}],"standard_charges":[{"gross_charge":319.23,"discounted_cash":191.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0315-01","type":"NDC"}],"standard_charges":[{"gross_charge":247.84,"discounted_cash":148.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0342-01","type":"NDC"}],"standard_charges":[{"gross_charge":247.84,"discounted_cash":148.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLIXIMAB-DYYB 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0809-01","type":"NDC"}],"standard_charges":[{"gross_charge":277.87,"discounted_cash":166.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1305-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1308-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.91,"discounted_cash":20.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1308-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":21.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1309-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.95,"discounted_cash":19.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1311-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.70,"discounted_cash":20.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1311-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.68,"discounted_cash":20.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-1542-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FILGRASTIM-AAFI 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0291-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.23,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-3034-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.58,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-6001-10","type":"NDC"}],"standard_charges":[{"gross_charge":37.67,"discounted_cash":22.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-6001-21","type":"NDC"}],"standard_charges":[{"gross_charge":37.36,"discounted_cash":22.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0074-3346-03","type":"NDC"}],"standard_charges":[{"gross_charge":5996.67,"discounted_cash":3598.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISANKIZUMAB-RZAA 600 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0074-5015-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.67,"discounted_cash":30.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0078-0180-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.38,"discounted_cash":20.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 20 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0078-0818-81","type":"NDC"}],"standard_charges":[{"gross_charge":676.56,"discounted_cash":405.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 30 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0078-0825-81","type":"NDC"}],"standard_charges":[{"gross_charge":675.86,"discounted_cash":405.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INCLISIRAN SODIUM 284 MG/1.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0078-1000-60","type":"NDC"}],"standard_charges":[{"gross_charge":35.39,"discounted_cash":21.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SECUKINUMAB 125 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0078-1168-61","type":"NDC"}],"standard_charges":[{"gross_charge":50.69,"discounted_cash":30.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0093-7334-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":6.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0093-9018-19","type":"NDC"}],"standard_charges":[{"gross_charge":5.89,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0093-9020-19","type":"NDC"}],"standard_charges":[{"gross_charge":18.05,"discounted_cash":10.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0121-0759-08","type":"NDC"}],"standard_charges":[{"gross_charge":2.20,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9098-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.04,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-4037-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-PVVR 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0249-01","type":"NDC"}],"standard_charges":[{"gross_charge":210.51,"discounted_cash":126.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB-PVVR 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0238-01","type":"NDC"}],"standard_charges":[{"gross_charge":211.41,"discounted_cash":126.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0758-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.98,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-0825-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-3475-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-3475-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-5140-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.07,"discounted_cash":29.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-5140-04","type":"NDC"}],"standard_charges":[{"gross_charge":49.07,"discounted_cash":29.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0009-7807-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.07,"discounted_cash":29.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONABOTULINUMTOXINA 100 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0023-1145-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":11.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONABOTULINUMTOXINA (COSMETIC) 50 UNITS IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0023-3919-50","type":"NDC"}],"standard_charges":[{"gross_charge":21.75,"discounted_cash":13.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON DEXTRAN 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0023-6082-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.65,"discounted_cash":32.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRON DEXTRAN 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0023-6082-10","type":"NDC"}],"standard_charges":[{"gross_charge":53.19,"discounted_cash":31.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0024-2792-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.82,"discounted_cash":12.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0024-2792-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.91,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RASBURICASE 1.5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0024-5150-10","type":"NDC"}],"standard_charges":[{"gross_charge":1059.03,"discounted_cash":635.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CABAZITAXEL 60 MG/1.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0024-5824-11","type":"NDC"}],"standard_charges":[{"gross_charge":955.49,"discounted_cash":573.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0024-5924-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.12,"discounted_cash":6.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0024-5926-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.20,"discounted_cash":10.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0069-0058-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-8740-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-8179-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-8176-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.77,"discounted_cash":0.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-8175-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.50,"discounted_cash":0.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-8174-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9161-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.32,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-4179-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-0019-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.09,"discounted_cash":0.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-0018-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0049-0520-84","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0049-0520-83","type":"NDC"}],"standard_charges":[{"gross_charge":9.33,"discounted_cash":5.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0049-0420-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":3.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0049-0014-81","type":"NDC"}],"standard_charges":[{"gross_charge":35.02,"discounted_cash":21.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0054-0064-47","type":"NDC"}],"standard_charges":[{"gross_charge":13.66,"discounted_cash":8.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6059-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.13,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9162-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.97,"discounted_cash":9.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9754-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.75,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9856-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9856-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9875-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9875-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.43,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9924-90","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOSTARLIMAB-GXLY 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0173-0898-03","type":"NDC"}],"standard_charges":[{"gross_charge":691.51,"discounted_cash":414.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0264-4100-90","type":"NDC"}],"standard_charges":[{"gross_charge":0.48,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0264-9376-88","type":"NDC"}],"standard_charges":[{"gross_charge":0.19,"discounted_cash":0.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE IN D5W 8-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0264-9598-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SINCALIDE 5 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-0556-15","type":"NDC"}],"standard_charges":[{"gross_charge":263.04,"discounted_cash":157.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFUR HEXAFLUORIDE MICROSPH 60.7-25 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-7099-16","type":"NDC"}],"standard_charges":[{"gross_charge":443.60,"discounted_cash":266.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENRALIZUMAB 30 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0310-1730-30","type":"NDC"}],"standard_charges":[{"gross_charge":555.19,"discounted_cash":333.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DURVALUMAB 120 MG/2.4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0310-4500-12","type":"NDC"}],"standard_charges":[{"gross_charge":244.89,"discounted_cash":146.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9746-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.07,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DURVALUMAB 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0310-4611-50","type":"NDC"}],"standard_charges":[{"gross_charge":244.25,"discounted_cash":146.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0049-03","type":"NDC"}],"standard_charges":[{"gross_charge":61.84,"discounted_cash":37.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0049-04","type":"NDC"}],"standard_charges":[{"gross_charge":64.34,"discounted_cash":38.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0049-41","type":"NDC"}],"standard_charges":[{"gross_charge":57.39,"discounted_cash":34.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0049-48","type":"NDC"}],"standard_charges":[{"gross_charge":58.31,"discounted_cash":34.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0054-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0072-25","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":9.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE IN D5W 8-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0411-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.38,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN (PORCINE) IN NACL 2000-0.9 UNIT/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0433-04","type":"NDC"}],"standard_charges":[{"gross_charge":20.72,"discounted_cash":12.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEMETREXED DISODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0722-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.12,"discounted_cash":7.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0803-04","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1007-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.20,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1047-02","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":31.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1049-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":6.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-0049-02","type":"NDC"}],"standard_charges":[{"gross_charge":62.34,"discounted_cash":37.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9729-01","type":"NDC"}],"standard_charges":[{"gross_charge":118.9,"discounted_cash":71.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9722-01","type":"NDC"}],"standard_charges":[{"gross_charge":68.1,"discounted_cash":40.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9721-24","type":"NDC"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":20.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9162-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":10.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.46,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9164-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.78,"discounted_cash":11.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9180-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.46,"discounted_cash":0.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9245-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.16,"discounted_cash":13.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9245-10","type":"NDC"}],"standard_charges":[{"gross_charge":23.07,"discounted_cash":13.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9333-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.22,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9398-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.83,"discounted_cash":46.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9431-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9431-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9503-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.73,"discounted_cash":79.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9512-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.06,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9514-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.89,"discounted_cash":19.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9519-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.42,"discounted_cash":6.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9519-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9553-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.06,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 50 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9555-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.7,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9721-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.18,"discounted_cash":20.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9720-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.95,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9719-10","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9719-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.74,"discounted_cash":14.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9689-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9682-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9161-25","type":"NDC"}],"standard_charges":[{"gross_charge":21.09,"discounted_cash":12.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9680-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9638-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.55,"discounted_cash":37.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9622-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.84,"discounted_cash":5.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9570-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.91,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9570-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.37,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENTOLAMINE MESYLATE 5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9564-01","type":"NDC"}],"standard_charges":[{"gross_charge":1462.55,"discounted_cash":877.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARGATROBAN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9559-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.15,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9673-25","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-155-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6063-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-405-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.48,"discounted_cash":9.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-405-16","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-413-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.63,"discounted_cash":0.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-549-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-848-11","type":"NDC"}],"standard_charges":[{"gross_charge":88.72,"discounted_cash":53.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-848-58","type":"NDC"}],"standard_charges":[{"gross_charge":82.79,"discounted_cash":49.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-931-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.81,"discounted_cash":17.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":41.06,"discounted_cash":24.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-251-05","type":"NDC"}],"standard_charges":[{"gross_charge":312.92,"discounted_cash":187.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":279.35,"discounted_cash":167.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-251-90","type":"NDC"}],"standard_charges":[{"gross_charge":313.23,"discounted_cash":187.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-251-91","type":"NDC"}],"standard_charges":[{"gross_charge":284.89,"discounted_cash":170.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-310-25","type":"NDC"}],"standard_charges":[{"gross_charge":299.52,"discounted_cash":179.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-310-90","type":"NDC"}],"standard_charges":[{"gross_charge":312.11,"discounted_cash":187.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-437-10","type":"NDC"}],"standard_charges":[{"gross_charge":273.91,"discounted_cash":164.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-437-91","type":"NDC"}],"standard_charges":[{"gross_charge":273.73,"discounted_cash":164.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-438-20","type":"NDC"}],"standard_charges":[{"gross_charge":272.11,"discounted_cash":163.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRAND NAME ONLY PRIVIGEN 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-438-92","type":"NDC"}],"standard_charges":[{"gross_charge":271.80,"discounted_cash":163.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":276.39,"discounted_cash":165.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRAND NAME ONLY PRIVIGEN 40 GM/400ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-439-40","type":"NDC"}],"standard_charges":[{"gross_charge":265.78,"discounted_cash":159.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":272.62,"discounted_cash":163.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 40 GM/400ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-439-93","type":"NDC"}],"standard_charges":[{"gross_charge":265.78,"discounted_cash":159.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":274.83,"discounted_cash":164.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTAZIDIME 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-236-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-240-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.90,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-241-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.06,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-311-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-410-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44206-436-05","type":"NDC"}],"standard_charges":[{"gross_charge":276.15,"discounted_cash":165.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-437-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.11,"discounted_cash":17.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-305-62","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-128-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.92,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-308-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.45,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.19,"discounted_cash":6.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-322-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"39822-0190-1","type":"NDC"}],"standard_charges":[{"gross_charge":123.5,"discounted_cash":74.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPHOTERICIN B 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"39822-1055-5","type":"NDC"}],"standard_charges":[{"gross_charge":83.05,"discounted_cash":49.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"39822-1100-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTAMIDINE ISETHIONATE 300 MG IN SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"39822-3030-2","type":"NDC"}],"standard_charges":[{"gross_charge":279.25,"discounted_cash":167.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-116-25","type":"NDC"}],"standard_charges":[{"gross_charge":34.65,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.53,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-159-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.34,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.64,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-164-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":31.79,"discounted_cash":19.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-164-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.68,"discounted_cash":6.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-130-74","type":"NDC"}],"standard_charges":[{"gross_charge":0.62,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-164-83","type":"NDC"}],"standard_charges":[{"gross_charge":13.23,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE (ANAPHYLAXIS) 30 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-168-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.57,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.72,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":185.38,"discounted_cash":111.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-221-10","type":"NDC"}],"standard_charges":[{"gross_charge":185.15,"discounted_cash":111.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42385-953-30","type":"NDC"}],"standard_charges":[{"gross_charge":175.55,"discounted_cash":105.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42494-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.73,"discounted_cash":59.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42494-415-25","type":"NDC"}],"standard_charges":[{"gross_charge":111.60,"discounted_cash":66.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43066-016-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43066-023-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.31,"discounted_cash":0.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43066-023-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.30,"discounted_cash":0.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43066-150-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.33,"discounted_cash":18.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43066-360-20","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"discounted_cash":9.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"43598-061-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.7,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"42023-164-89","type":"NDC"}],"standard_charges":[{"gross_charge":11.86,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-451-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-611-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-611-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CERTOLIZUMAB PEGOL 200 MG/ML SC PSKT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50474-710-79","type":"NDC"}],"standard_charges":[{"gross_charge":42.92,"discounted_cash":25.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RABIES VACCINE, PCEC IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50632-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":1239.8,"discounted_cash":743.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RABIES VACCINE, PCEC IM SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50632-013-01","type":"NDC"}],"standard_charges":[{"gross_charge":1280.23,"discounted_cash":768.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 1 GM/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50742-520-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.80,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51144-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":141.87,"discounted_cash":85.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51144-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":141.87,"discounted_cash":85.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRENTUXIMAB VEDOTIN 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51144-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":948.85,"discounted_cash":569.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51754-1200-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51754-1200-3","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51754-4000-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51754-4020-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51754-5060-1","type":"NDC"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE PF 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"54288-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.01,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.64,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVONORGESTREL 20 MCG/DAY IU IUD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50419-423-01","type":"NDC"}],"standard_charges":[{"gross_charge":3465.75,"discounted_cash":2079.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"54288-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"54288-119-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.59,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"54288-142-10","type":"NDC"}],"standard_charges":[{"gross_charge":106.94,"discounted_cash":64.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"54288-147-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"54288-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.21,"discounted_cash":25.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"54288-166-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.22,"discounted_cash":18.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55111-527-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DECITABINE 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55111-556-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.49,"discounted_cash":29.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55111-678-11","type":"NDC"}],"standard_charges":[{"gross_charge":33.65,"discounted_cash":20.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55111-680-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.92,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55111-685-07","type":"NDC"}],"standard_charges":[{"gross_charge":56.60,"discounted_cash":33.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55135-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":139.97,"discounted_cash":83.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-116-20","type":"NDC"}],"standard_charges":[{"gross_charge":43.65,"discounted_cash":26.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-117-20","type":"NDC"}],"standard_charges":[{"gross_charge":31.08,"discounted_cash":18.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50268-527-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.16,"discounted_cash":5.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.48,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATEZOLIZUMAB 840 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-918-01","type":"NDC"}],"standard_charges":[{"gross_charge":269.50,"discounted_cash":161.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-620-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-621-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-621-24","type":"NDC"}],"standard_charges":[{"gross_charge":0.83,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-702-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.32,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-706-25","type":"NDC"}],"standard_charges":[{"gross_charge":30.59,"discounted_cash":18.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"44567-802-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"47335-049-40","type":"NDC"}],"standard_charges":[{"gross_charge":1748.77,"discounted_cash":1049.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1804.38,"discounted_cash":1082.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"47335-050-40","type":"NDC"}],"standard_charges":[{"gross_charge":1938.07,"discounted_cash":1162.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1949.82,"discounted_cash":1169.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"49281-215-58","type":"NDC"}],"standard_charges":[{"gross_charge":144.50,"discounted_cash":86.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLIOVIRUS VACCINE INACTIVATED IJ INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"49281-860-10","type":"NDC"}],"standard_charges":[{"gross_charge":151.9,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLIOVIRUS VACCINE INACTIVATED IJ INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"49281-860-78","type":"NDC"}],"standard_charges":[{"gross_charge":158.05,"discounted_cash":94.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50090-1831-0","type":"NDC"}],"standard_charges":[{"gross_charge":153.9,"discounted_cash":92.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OMALIZUMAB 150 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-040-62","type":"NDC"}],"standard_charges":[{"gross_charge":136.14,"discounted_cash":81.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALTEPLASE 2 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-041-64","type":"NDC"}],"standard_charges":[{"gross_charge":273.41,"discounted_cash":164.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATEZOLIZUMAB 1200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-917-01","type":"NDC"}],"standard_charges":[{"gross_charge":269.40,"discounted_cash":161.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OMALIZUMAB 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-215-03","type":"NDC"}],"standard_charges":[{"gross_charge":139.18,"discounted_cash":83.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OMALIZUMAB 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-215-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.42,"discounted_cash":82.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCRELIZUMAB 300 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":197.06,"discounted_cash":118.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PERTUZUMAB 420 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.28,"discounted_cash":38.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOCILIZUMAB 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.49,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOCILIZUMAB 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.48,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":380.84,"discounted_cash":228.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 30 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":379.66,"discounted_cash":227.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-088-01","type":"NDC"}],"standard_charges":[{"gross_charge":159.13,"discounted_cash":95.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-087-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.81,"discounted_cash":95.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OBINUTUZUMAB 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":243.14,"discounted_cash":145.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITUXIMAB 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-053-06","type":"NDC"}],"standard_charges":[{"gross_charge":275.48,"discounted_cash":165.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TENECTEPLASE 50 MG IV KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-120-47","type":"NDC"}],"standard_charges":[{"gross_charge":420.05,"discounted_cash":252.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-306-60","type":"NDC"}],"standard_charges":[{"gross_charge":0.55,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-284-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-244-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.00,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"APREPITANT 40 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-2321-06","type":"NDC"}],"standard_charges":[{"gross_charge":34.12,"discounted_cash":20.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"APREPITANT 125 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-2323-06","type":"NDC"}],"standard_charges":[{"gross_charge":31.27,"discounted_cash":18.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3059-95","type":"NDC"}],"standard_charges":[{"gross_charge":33.06,"discounted_cash":19.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERUMOXYTOL 510 MG/17ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3154-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OLANZAPINE 10 MG IM SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3159-72","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3238-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3404-85","type":"NDC"}],"standard_charges":[{"gross_charge":24.56,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3408-80","type":"NDC"}],"standard_charges":[{"gross_charge":30.26,"discounted_cash":18.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":17.28,"discounted_cash":10.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3408-95","type":"NDC"}],"standard_charges":[{"gross_charge":15.29,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VORICONAZOLE 200 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3416-94","type":"NDC"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3531-91","type":"NDC"}],"standard_charges":[{"gross_charge":59.85,"discounted_cash":35.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3540-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-9261-95","type":"NDC"}],"standard_charges":[{"gross_charge":22.78,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-9514-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-9273-80","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":10.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0904-6836-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.29,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISONE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0904-6923-61","type":"NDC"}],"standard_charges":[{"gross_charge":0.45,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0904-7141-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0904-7304-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2658-04","type":"NDC"}],"standard_charges":[{"gross_charge":333.25,"discounted_cash":199.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-04","type":"NDC"}],"standard_charges":[{"gross_charge":260.78,"discounted_cash":156.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-05","type":"NDC"}],"standard_charges":[{"gross_charge":251.81,"discounted_cash":151.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-06","type":"NDC"}],"standard_charges":[{"gross_charge":250.95,"discounted_cash":150.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 30 GM/300ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-07","type":"NDC"}],"standard_charges":[{"gross_charge":252.31,"discounted_cash":151.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":257.06,"discounted_cash":154.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-11","type":"NDC"}],"standard_charges":[{"gross_charge":250.8,"discounted_cash":150.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-12","type":"NDC"}],"standard_charges":[{"gross_charge":251.29,"discounted_cash":150.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMMUNE GLOBULIN (HUMAN) 30 GM/300ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-2700-13","type":"NDC"}],"standard_charges":[{"gross_charge":253.31,"discounted_cash":151.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.2,"discounted_cash":39.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0904-6624-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-8777-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-4239-81","type":"NDC"}],"standard_charges":[{"gross_charge":20.97,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-4239-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.63,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6125-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.77,"discounted_cash":19.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6125-25","type":"NDC"}],"standard_charges":[{"gross_charge":31.72,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6127-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":18.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6127-25","type":"NDC"}],"standard_charges":[{"gross_charge":30.78,"discounted_cash":18.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6146-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.81,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6146-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.75,"discounted_cash":0.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6151-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.45,"discounted_cash":20.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6175-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.56,"discounted_cash":6.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6175-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.16,"discounted_cash":7.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6182-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.60,"discounted_cash":39.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6182-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.38,"discounted_cash":39.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6188-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.03,"discounted_cash":0.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6205-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.82,"discounted_cash":37.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.69,"discounted_cash":0.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6205-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.68,"discounted_cash":35.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.60,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-3671-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PACLITAXEL 30 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-3218-81","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PACLITAXEL 30 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-3218-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-0113-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0703-0113-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.14,"discounted_cash":0.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.21,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"10019-120-39","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":5.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6253-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.81,"discounted_cash":17.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6228-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.42,"discounted_cash":16.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6210-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6210-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.83,"discounted_cash":5.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.70,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6207-25","type":"NDC"}],"standard_charges":[{"gross_charge":27.42,"discounted_cash":16.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6207-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.60,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6228-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.31,"discounted_cash":14.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6063-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.61,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLEVIDIPINE 50 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"10122-611-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CANGRELOR TETRASODIUM 50 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"10122-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.20,"discounted_cash":35.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-207-51","type":"NDC"}],"standard_charges":[{"gross_charge":25.55,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MITOMYCIN 5 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-250-20","type":"NDC"}],"standard_charges":[{"gross_charge":950.14,"discounted_cash":570.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-251-50","type":"NDC"}],"standard_charges":[{"gross_charge":574.54,"discounted_cash":344.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MITOMYCIN 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-252-51","type":"NDC"}],"standard_charges":[{"gross_charge":638.35,"discounted_cash":383.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PACLITAXEL 30 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-255-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.81,"discounted_cash":0.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-305-20","type":"NDC"}],"standard_charges":[{"gross_charge":190.59,"discounted_cash":114.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-313-82","type":"NDC"}],"standard_charges":[{"gross_charge":19.59,"discounted_cash":11.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-318-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.09,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-400-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-402-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARGATROBAN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-414-50","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-461-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.40,"discounted_cash":27.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.50,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-502-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.9,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-191-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-608-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.96,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.06,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-608-51","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.31,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-676-20","type":"NDC"}],"standard_charges":[{"gross_charge":178.65,"discounted_cash":107.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.99,"discounted_cash":16.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.37,"discounted_cash":22.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-815-30","type":"NDC"}],"standard_charges":[{"gross_charge":19.74,"discounted_cash":11.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-826-82","type":"NDC"}],"standard_charges":[{"gross_charge":144.45,"discounted_cash":86.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-830-82","type":"NDC"}],"standard_charges":[{"gross_charge":215.15,"discounted_cash":129.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ECULIZUMAB 300 MG/30ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25682-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":127.43,"discounted_cash":76.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":637.15,"discounted_cash":382.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAVULIZUMAB-CWVZ 1100 MG/11ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25682-025-01","type":"NDC"}],"standard_charges":[{"gross_charge":625.74,"discounted_cash":375.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAVULIZUMAB-CWVZ 1100 MG/11ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25682-028-01","type":"NDC"}],"standard_charges":[{"gross_charge":632.00,"discounted_cash":379.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-033-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"36000-048-24","type":"NDC"}],"standard_charges":[{"gross_charge":23.18,"discounted_cash":13.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICAFUNGIN SODIUM 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-191-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-184-87","type":"NDC"}],"standard_charges":[{"gross_charge":45.78,"discounted_cash":27.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-184-82","type":"NDC"}],"standard_charges":[{"gross_charge":76.9,"discounted_cash":46.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETANUS-DIPHTHERIA TOXOIDS TD 2-2 LF/0.5ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-131-00","type":"NDC"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":65.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"APREPITANT 80 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13668-592-85","type":"NDC"}],"standard_charges":[{"gross_charge":31.38,"discounted_cash":18.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"14789-116-05","type":"NDC"}],"standard_charges":[{"gross_charge":320.3,"discounted_cash":192.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"14789-116-07","type":"NDC"}],"standard_charges":[{"gross_charge":320.3,"discounted_cash":192.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"15054-0043-1","type":"NDC"}],"standard_charges":[{"gross_charge":276.49,"discounted_cash":165.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANREOTIDE ACETATE 60 MG/0.2ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"15054-1060-4","type":"NDC"}],"standard_charges":[{"gross_charge":297.67,"discounted_cash":178.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"15054-1120-4","type":"NDC"}],"standard_charges":[{"gross_charge":233.64,"discounted_cash":140.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"16729-042-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"16729-114-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOPOTECAN HCL 4 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"16729-243-31","type":"NDC"}],"standard_charges":[{"gross_charge":43.71,"discounted_cash":26.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"16729-295-12","type":"NDC"}],"standard_charges":[{"gross_charge":23.07,"discounted_cash":13.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"16729-526-08","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"16729-526-63","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYALURONIDASE HUMAN 150 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"18657-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYALURONIDASE HUMAN 150 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"18657-117-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.27,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"19515-810-41","type":"NDC"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":50.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-240-41","type":"NDC"}],"standard_charges":[{"gross_charge":30.86,"discounted_cash":18.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-121-20","type":"NDC"}],"standard_charges":[{"gross_charge":21.28,"discounted_cash":12.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-052-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"24201-010-50","type":"NDC"}],"standard_charges":[{"gross_charge":132.77,"discounted_cash":79.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-689-41","type":"NDC"}],"standard_charges":[{"gross_charge":4.22,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-689-31","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-548-42","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLEVIDIPINE 50 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"10122-611-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-547-31","type":"NDC"}],"standard_charges":[{"gross_charge":7.08,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-345-32","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-313-31","type":"NDC"}],"standard_charges":[{"gross_charge":126.95,"discounted_cash":76.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-294-41","type":"NDC"}],"standard_charges":[{"gross_charge":40.09,"discounted_cash":24.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-294-31","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":24.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":38.91,"discounted_cash":23.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-258-32","type":"NDC"}],"standard_charges":[{"gross_charge":5.62,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-345-42","type":"NDC"}],"standard_charges":[{"gross_charge":0.96,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71266-2001-2","type":"NDC"}],"standard_charges":[{"gross_charge":80.66,"discounted_cash":48.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69918-901-12","type":"NDC"}],"standard_charges":[{"gross_charge":24.22,"discounted_cash":14.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDOMETHACIN 25 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-637-10","type":"NDC"}],"standard_charges":[{"gross_charge":137.05,"discounted_cash":82.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERROUS SULFATE 325 (65 FE) MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7591-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7728-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EUCERIN EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7751-27","type":"NDC"}],"standard_charges":[{"gross_charge":31.73,"discounted_cash":19.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":32.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":31.92,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7914-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.45,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0990-6138-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.38,"discounted_cash":37.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYPROMELLOSE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0998-0408-15","type":"NDC"}],"standard_charges":[{"gross_charge":106.9,"discounted_cash":64.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM CHLORIDE 64 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10006-70013","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIACIN ER 250 MG PO CAP-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10006-70020","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM OXIDE -MG SUPPLEMENT 400 (240 MG) MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10006-70028","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10006-70038","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7427-30","type":"NDC"}],"standard_charges":[{"gross_charge":28.15,"discounted_cash":16.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10702-018-50","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOLIC ACID 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"11534-165-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"11610-61040","type":"NDC"}],"standard_charges":[{"gross_charge":31.15,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"11917-11271","type":"NDC"}],"standard_charges":[{"gross_charge":5.98,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILVER NITRATE-POT NITRATE 75-25 % EX MISC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"12870-0001-1","type":"NDC"}],"standard_charges":[{"gross_charge":13.67,"discounted_cash":8.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13107-031-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13107-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL 16.2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13517-110-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13668-009-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13668-091-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13668-092-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.85,"discounted_cash":7.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13668-093-90","type":"NDC"}],"standard_charges":[{"gross_charge":9.39,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DAPSONE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13925-505-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"14537-967-75","type":"NDC"}],"standard_charges":[{"gross_charge":89.26,"discounted_cash":53.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARTIFICIAL TEARS 83-15 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10119-02239","type":"NDC"}],"standard_charges":[{"gross_charge":40.84,"discounted_cash":24.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"14789-250-07","type":"NDC"}],"standard_charges":[{"gross_charge":54.61,"discounted_cash":32.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7346-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.70,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7279-66","type":"NDC"}],"standard_charges":[{"gross_charge":8.28,"discounted_cash":4.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.76,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7110-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.68,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7119-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUSPIRONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7122-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.31,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7123-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7124-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7126-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.67,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZONATATE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7153-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7177-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.79,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7178-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7180-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.10,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCUSATE SODIUM 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7183-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATENOLOL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7187-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.26,"discounted_cash":1.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7191-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.81,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7193-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7193-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL ER (SR) 150 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7214-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7217-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7218-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.87,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOLIC ACID 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7224-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7237-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7244-68","type":"NDC"}],"standard_charges":[{"gross_charge":7.07,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES 8.6 MG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7252-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.60,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES 8.6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7252-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.61,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 650 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7261-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7265-41","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":7.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7276-92","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-128-48","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-664-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL 20 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-675-15","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"21922-016-07","type":"NDC"}],"standard_charges":[{"gross_charge":1143.85,"discounted_cash":686.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PERMETHRIN 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"21922-021-07","type":"NDC"}],"standard_charges":[{"gross_charge":309.88,"discounted_cash":185.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-026-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHIMAZOLE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-071-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-166-31","type":"NDC"}],"standard_charges":[{"gross_charge":30.19,"discounted_cash":18.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-166-41","type":"NDC"}],"standard_charges":[{"gross_charge":29.69,"discounted_cash":17.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-246-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.38,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIMODIPINE 30 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-512-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.42,"discounted_cash":5.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIMODIPINE 30 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-512-11","type":"NDC"}],"standard_charges":[{"gross_charge":47.90,"discounted_cash":28.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-524-31","type":"NDC"}],"standard_charges":[{"gross_charge":36.13,"discounted_cash":21.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-661-31","type":"NDC"}],"standard_charges":[{"gross_charge":437.45,"discounted_cash":262.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-385-55","type":"NDC"}],"standard_charges":[{"gross_charge":70.4,"discounted_cash":42.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-434-05","type":"NDC"}],"standard_charges":[{"gross_charge":83.45,"discounted_cash":50.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZINC SULFATE 220 (50 ZN) MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-04000","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-457-05","type":"NDC"}],"standard_charges":[{"gross_charge":66.3,"discounted_cash":39.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-485-10","type":"NDC"}],"standard_charges":[{"gross_charge":135.6,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCHOLINE CHLORIDE 20 MG IO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-539-20","type":"NDC"}],"standard_charges":[{"gross_charge":401.53,"discounted_cash":240.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-555-55","type":"NDC"}],"standard_charges":[{"gross_charge":93.55,"discounted_cash":56.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-631-10","type":"NDC"}],"standard_charges":[{"gross_charge":269.35,"discounted_cash":161.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-635-62","type":"NDC"}],"standard_charges":[{"gross_charge":269.35,"discounted_cash":161.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFACETAMIDE SODIUM 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-670-04","type":"NDC"}],"standard_charges":[{"gross_charge":172.5,"discounted_cash":103.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-720-02","type":"NDC"}],"standard_charges":[{"gross_charge":181.5,"discounted_cash":108.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-730-06","type":"NDC"}],"standard_charges":[{"gross_charge":126.35,"discounted_cash":75.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-735-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.45,"discounted_cash":38.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-795-35","type":"NDC"}],"standard_charges":[{"gross_charge":72.05,"discounted_cash":43.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-830-60","type":"NDC"}],"standard_charges":[{"gross_charge":72.05,"discounted_cash":43.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-910-19","type":"NDC"}],"standard_charges":[{"gross_charge":53.90,"discounted_cash":32.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24357-701-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":18.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24357-701-06","type":"NDC"}],"standard_charges":[{"gross_charge":30.65,"discounted_cash":18.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-463-25","type":"NDC"}],"standard_charges":[{"gross_charge":83.1,"discounted_cash":49.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELATONIN 3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-03601","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELATONIN 3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-03600","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL 20 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-675-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.94,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAFENIDE ACETATE 85 MG/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-723-60","type":"NDC"}],"standard_charges":[{"gross_charge":235.75,"discounted_cash":141.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-743-09","type":"NDC"}],"standard_charges":[{"gross_charge":7.42,"discounted_cash":4.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.90,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIMEPIRIDE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-773-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMOTRIGINE 25 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-786-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-813-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMANTADINE HCL 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16571-834-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIMEPIRIDE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BICALUTAMIDE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-023-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.20,"discounted_cash":28.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LETROZOLE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-034-15","type":"NDC"}],"standard_charges":[{"gross_charge":48.7,"discounted_cash":29.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-137-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMVASTATIN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-156-15","type":"NDC"}],"standard_charges":[{"gross_charge":11.5,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-182-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-184-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SPIRONOLACTONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-225-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.80,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.8,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN D3 25 MCG (1000 UT) PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-03300","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.07,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-01900","type":"NDC"}],"standard_charges":[{"gross_charge":4.50,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-12 1000 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-00600","type":"NDC"}],"standard_charges":[{"gross_charge":3.57,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASCORBIC ACID 250 MG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-00100","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.56,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOCARBAMOL 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7058-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.58,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"17238-900-99","type":"NDC"}],"standard_charges":[{"gross_charge":5.03,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZOCAINE-MENTHOL 20-0.5 % EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16864-68003","type":"NDC"}],"standard_charges":[{"gross_charge":37.67,"discounted_cash":22.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALUM SULFATE-CA ACETATE EX PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16864-240-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.51,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-452-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CINACALCET HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-440-10","type":"NDC"}],"standard_charges":[{"gross_charge":78.69,"discounted_cash":47.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPLERENONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-293-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.92,"discounted_cash":7.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"16729-239-30","type":"NDC"}],"standard_charges":[{"gross_charge":82.36,"discounted_cash":49.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"17238-900-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXEPIN HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7052-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7049-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7046-06","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METFORMIN HCL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5634-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PAROXETINE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5677-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.43,"discounted_cash":6.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WHITE PETROLATUM EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5731-82","type":"NDC"}],"standard_charges":[{"gross_charge":30.4,"discounted_cash":18.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5784-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.55,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5785-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.09,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR 200 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5789-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.89,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN D3 10 MCG (400 UNIT) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5823-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.36,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5853-60","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5853-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5854-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.40,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5855-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5892-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.24,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN HCL 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5959-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRIMIDONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5559-60","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6082-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CITALOPRAM HYDROBROMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6085-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":6.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6290-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATORVASTATIN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6290-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6292-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6292-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6294-61","type":"NDC"}],"standard_charges":[{"gross_charge":15.10,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 1.5625 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6300-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.01,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.80,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6302-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.06,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL SUCCINATE ER 12.5 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6322-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETRAHYDROZOLINE HCL 0.05 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6334-35","type":"NDC"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":15.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6351-61","type":"NDC"}],"standard_charges":[{"gross_charge":40.43,"discounted_cash":24.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6352-61","type":"NDC"}],"standard_charges":[{"gross_charge":45.7,"discounted_cash":27.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6353-61","type":"NDC"}],"standard_charges":[{"gross_charge":64.73,"discounted_cash":38.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6084-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.57,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5529-87","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MULTIVITAMIN-MINERALS PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5492-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTOXIFYLLINE ER 400 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5448-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1540-89","type":"NDC"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETHACRYNIC ACID 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1690-11","type":"NDC"}],"standard_charges":[{"gross_charge":60.57,"discounted_cash":36.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE ER 100 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-6022-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-6032-12","type":"NDC"}],"standard_charges":[{"gross_charge":21.49,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 40 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-6045-50","type":"NDC"}],"standard_charges":[{"gross_charge":25.20,"discounted_cash":15.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-7123-89","type":"NDC"}],"standard_charges":[{"gross_charge":6.69,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 500 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-7124-89","type":"NDC"}],"standard_charges":[{"gross_charge":7.13,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOL 89 % EX SWAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0884-6297-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOL 89 % EX SWAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0884-6297-30","type":"NDC"}],"standard_charges":[{"gross_charge":13.73,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORPHENIRAMINE MALEATE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-0012-59","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMITRIPTYLINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-0201-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.00,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-0411-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.00,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN C 125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-0522-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASCORBIC ACID 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-0523-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.41,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.34,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OYSTER SHELL CALCIUM 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-1883-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIMENHYDRINATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-2051-59","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5395-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRENATAL 27-0.8 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5313-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5306-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.93,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUAIFENESIN 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5154-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.46,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-12 125 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-4218-13","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SALINE NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-3865-75","type":"NDC"}],"standard_charges":[{"gross_charge":25.5,"discounted_cash":15.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6369-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.54,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE 50 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-3854-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-2725-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":3.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALLOPURINOL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-2613-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALAMINE 8-8 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-2533-21","type":"NDC"}],"standard_charges":[{"gross_charge":27.45,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIACIN 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-2272-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN A 3 MG (10000 UT) PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-2085-60","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-2056-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMETHICONE 80 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24385-118-78","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6370-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.34,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OLANZAPINE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6377-61","type":"NDC"}],"standard_charges":[{"gross_charge":35.22,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN EXTRA STRENGTH 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6730-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6773-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 81 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6794-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.99,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6797-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6798-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6799-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6808-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.60,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6817-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6817-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.15,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6824-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAZODONE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6868-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.23,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SPIRONOLACTONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6927-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.77,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUAIFENESIN ER 600 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6718-39","type":"NDC"}],"standard_charges":[{"gross_charge":7.08,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 12.5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6949-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.93,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6950-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 37.5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6951-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.23,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6953-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.37,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6966-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.01,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6985-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PSEUDOEPHEDRINE HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6990-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6993-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.10,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7001-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.96,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMOTRIGINE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7008-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.45,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.65,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7016-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7023-67","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6705-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 400 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6667-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 300 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6666-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISACODYL 5 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6407-61","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM CARBONATE ANTACID 500 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6412-92","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6426-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.73,"discounted_cash":8.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6441-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6442-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.69,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE ER 15 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6449-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.53,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6450-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.45,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6475-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DONEPEZIL HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6477-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARTIFICIAL TEARS 83-15 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6488-38","type":"NDC"}],"standard_charges":[{"gross_charge":37.2,"discounted_cash":22.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6501-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":4.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEMANTINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6505-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEMANTINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6505-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.10,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6519-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.70,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.20,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6665-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6663-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.94,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6645-24","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6640-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.08,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6638-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.26,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6371-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6627-35","type":"NDC"}],"standard_charges":[{"gross_charge":27.4,"discounted_cash":16.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6617-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 125 MG PO CSDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6615-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL 32.4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6575-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.21,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6558-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.07,"discounted_cash":4.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6553-04","type":"NDC"}],"standard_charges":[{"gross_charge":451.35,"discounted_cash":270.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6622-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1520-89","type":"NDC"}],"standard_charges":[{"gross_charge":3.63,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24385-379-26","type":"NDC"}],"standard_charges":[{"gross_charge":6.76,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-319-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.30,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOCONAZOLE 2 % EX SHAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-465-64","type":"NDC"}],"standard_charges":[{"gross_charge":97.4,"discounted_cash":58.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-580-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.63,"discounted_cash":30.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-580-46","type":"NDC"}],"standard_charges":[{"gross_charge":60.8,"discounted_cash":36.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 650 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-730-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 650 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-730-33","type":"NDC"}],"standard_charges":[{"gross_charge":5.69,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-732-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.20,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-732-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-880-14","type":"NDC"}],"standard_charges":[{"gross_charge":84.95,"discounted_cash":50.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45963-439-65","type":"NDC"}],"standard_charges":[{"gross_charge":43.05,"discounted_cash":25.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-165-10","type":"NDC"}],"standard_charges":[{"gross_charge":37.85,"discounted_cash":22.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN (LAXATIVE) 1.2 G RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-222-63","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-353-74","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-414-03","type":"NDC"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADAPALENE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-453-84","type":"NDC"}],"standard_charges":[{"gross_charge":685.5,"discounted_cash":411.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-424-62","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-450-21","type":"NDC"}],"standard_charges":[{"gross_charge":7.94,"discounted_cash":4.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAFFEINE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-457-73","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-556-05","type":"NDC"}],"standard_charges":[{"gross_charge":43.75,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-557-05","type":"NDC"}],"standard_charges":[{"gross_charge":39.55,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-605-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.28,"discounted_cash":25.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-646-54","type":"NDC"}],"standard_charges":[{"gross_charge":60.95,"discounted_cash":36.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMINS A & D EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-726-26","type":"NDC"}],"standard_charges":[{"gross_charge":35.25,"discounted_cash":21.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-740-38","type":"NDC"}],"standard_charges":[{"gross_charge":11.46,"discounted_cash":6.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOL 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-748-76","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":21.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-752-52","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARTIFICIAL TEARS 83-15 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-757-37","type":"NDC"}],"standard_charges":[{"gross_charge":55.22,"discounted_cash":33.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-789-29","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":24.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GM/60ML CO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46287-006-60","type":"NDC"}],"standard_charges":[{"gross_charge":79.39,"discounted_cash":47.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":79.51,"discounted_cash":47.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-444-27","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM PHOSPHATES(71 MEQ K) 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46287-024-15","type":"NDC"}],"standard_charges":[{"gross_charge":103.45,"discounted_cash":62.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-434-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.2,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CETIRIZINE-PSEUDOEPHEDRINE ER 5-120 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-147-62","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRIL MALEATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-547-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRIL MALEATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-548-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.32,"discounted_cash":6.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRILAT 1.25 MG/ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-078-11","type":"NDC"}],"standard_charges":[{"gross_charge":40.42,"discounted_cash":24.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":36.81,"discounted_cash":22.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-210-25","type":"NDC"}],"standard_charges":[{"gross_charge":34.68,"discounted_cash":20.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-210-40","type":"NDC"}],"standard_charges":[{"gross_charge":178.85,"discounted_cash":107.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-326-75","type":"NDC"}],"standard_charges":[{"gross_charge":679.84,"discounted_cash":407.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CAP-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-339-60","type":"NDC"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-436-35","type":"NDC"}],"standard_charges":[{"gross_charge":85.6,"discounted_cash":51.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-448-28","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-448-71","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SEVELAMER CARBONATE 0.8 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-478-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.51,"discounted_cash":28.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAPROXEN SODIUM 275 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-494-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-561-79","type":"NDC"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":25.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-358-03","type":"NDC"}],"standard_charges":[{"gross_charge":30.35,"discounted_cash":18.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.36,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-582-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":15.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-919-11","type":"NDC"}],"standard_charges":[{"gross_charge":961.75,"discounted_cash":577.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NUTRISOURCE FIBER PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43900-97647","type":"NDC"}],"standard_charges":[{"gross_charge":5.86,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANSINOH LANOLIN EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44677-10202","type":"NDC"}],"standard_charges":[{"gross_charge":27.54,"discounted_cash":16.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-048-11","type":"NDC"}],"standard_charges":[{"gross_charge":87.65,"discounted_cash":52.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-056-35","type":"NDC"}],"standard_charges":[{"gross_charge":144.15,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-060-00","type":"NDC"}],"standard_charges":[{"gross_charge":17.39,"discounted_cash":10.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.9,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-064-05","type":"NDC"}],"standard_charges":[{"gross_charge":80.1,"discounted_cash":48.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-064-35","type":"NDC"}],"standard_charges":[{"gross_charge":30.15,"discounted_cash":18.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-064-36","type":"NDC"}],"standard_charges":[{"gross_charge":43.65,"discounted_cash":26.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-065-35","type":"NDC"}],"standard_charges":[{"gross_charge":48.25,"discounted_cash":28.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MESALAMINE 4 G RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-098-46","type":"NDC"}],"standard_charges":[{"gross_charge":61.05,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-122-60","type":"NDC"}],"standard_charges":[{"gross_charge":7.4,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43598-580-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.48,"discounted_cash":15.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SORBITOL 70 % SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46287-500-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":9.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOFETILIDE 125 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47335-061-86","type":"NDC"}],"standard_charges":[{"gross_charge":25.55,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LURASIDONE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47335-578-83","type":"NDC"}],"standard_charges":[{"gross_charge":128.51,"discounted_cash":77.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-106-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-132-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.41,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL 75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-142-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.65,"discounted_cash":4.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-143-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.71,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-143-15","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEPHALEXIN 500 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-152-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.50,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CILOSTAZOL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-176-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CILOSTAZOL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-176-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.1,"discounted_cash":6.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-184-11","type":"NDC"}],"standard_charges":[{"gross_charge":50.52,"discounted_cash":30.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLCHICINE 0.6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-187-11","type":"NDC"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLCHICINE 0.3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-187-15","type":"NDC"}],"standard_charges":[{"gross_charge":22.25,"discounted_cash":13.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-190-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.13,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-191-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-106-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.09,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-259-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FINASTERIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-314-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLECAINIDE ACETATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-321-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.10,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUDROCORTISONE ACETATE 0.05 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-330-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.31,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-330-15","type":"NDC"}],"standard_charges":[{"gross_charge":7.62,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-336-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.11,"discounted_cash":8.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-339-11","type":"NDC"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":25.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-361-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":2.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.71,"discounted_cash":2.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-361-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-362-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-401-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-411-24","type":"NDC"}],"standard_charges":[{"gross_charge":57.15,"discounted_cash":34.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDOMETHACIN 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-430-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-260-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.70,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARIPIPRAZOLE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-088-15","type":"NDC"}],"standard_charges":[{"gross_charge":77.7,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARIPIPRAZOLE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-088-11","type":"NDC"}],"standard_charges":[{"gross_charge":76.18,"discounted_cash":45.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LURASIDONE HCL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47335-684-83","type":"NDC"}],"standard_charges":[{"gross_charge":129.2,"discounted_cash":77.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47335-902-88","type":"NDC"}],"standard_charges":[{"gross_charge":13.94,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47335-931-40","type":"NDC"}],"standard_charges":[{"gross_charge":52.3,"discounted_cash":31.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYOSCYAMINE SULFATE ER 0.375 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47781-014-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":5.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 12 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47781-423-47","type":"NDC"}],"standard_charges":[{"gross_charge":54.01,"discounted_cash":32.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47781-428-11","type":"NDC"}],"standard_charges":[{"gross_charge":196.8,"discounted_cash":118.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47781-470-13","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINERAL OIL PO OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"48433-202-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":3.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES 8.8 MG/5ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"48433-219-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":6.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM PHOSPHATE DIBASIC POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49452-6925-1","type":"NDC"}],"standard_charges":[{"gross_charge":23.65,"discounted_cash":14.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49502-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":485.05,"discounted_cash":291.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN GLARGINE-YFGN 100 UNIT/ML SC SOPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49502-394-71","type":"NDC"}],"standard_charges":[{"gross_charge":81.3,"discounted_cash":48.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOLUTEGRAVIR SODIUM 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49702-228-13","type":"NDC"}],"standard_charges":[{"gross_charge":226.61,"discounted_cash":135.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXEPIN HCL 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49884-222-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":6.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINOXIDIL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49884-256-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINOXIDIL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49884-257-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEGESTROL ACETATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49884-289-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-074-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.86,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-061-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":8.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-901-18","type":"NDC"}],"standard_charges":[{"gross_charge":138.91,"discounted_cash":83.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DORNASE ALFA 2.5 MG/2.5ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-100-40","type":"NDC"}],"standard_charges":[{"gross_charge":387.37,"discounted_cash":232.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DORNASE ALFA 2.5 MG/2.5ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-100-39","type":"NDC"}],"standard_charges":[{"gross_charge":391.53,"discounted_cash":234.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50228-482-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRIL MALEATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-546-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.15,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA ER 50-200 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50228-461-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.05,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50228-119-90","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":15.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50111-648-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAZODONE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50111-561-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50111-398-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":3.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYUREA 500 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49884-724-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.18,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHIMAZOLE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49884-641-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA ER 25-100 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50228-460-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRIL MALEATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-545-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-406-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-400-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMITRIPTYLINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.45,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALLBEE/C PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31604-01338","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.80,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IVABRADINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-053-60","type":"NDC"}],"standard_charges":[{"gross_charge":32.05,"discounted_cash":19.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-203-32","type":"NDC"}],"standard_charges":[{"gross_charge":168.11,"discounted_cash":100.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-530-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-531-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.52,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOCARBAMOL 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-534-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.34,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ABACAVIR SULFATE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-557-60","type":"NDC"}],"standard_charges":[{"gross_charge":26.85,"discounted_cash":16.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-632-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROFLUMILAST 250 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-676-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.5,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR 200 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-681-47","type":"NDC"}],"standard_charges":[{"gross_charge":48.88,"discounted_cash":29.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-396-19","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-687-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.19,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MONTELUKAST SODIUM 5 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-728-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":9.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-812-60","type":"NDC"}],"standard_charges":[{"gross_charge":32.33,"discounted_cash":19.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLCHICINE 0.6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-899-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.64,"discounted_cash":12.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMIVUDINE 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-001-09","type":"NDC"}],"standard_charges":[{"gross_charge":19.84,"discounted_cash":11.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMCICLOVIR 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-026-07","type":"NDC"}],"standard_charges":[{"gross_charge":35.65,"discounted_cash":21.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIOGLITAZONE HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-054-07","type":"NDC"}],"standard_charges":[{"gross_charge":19.46,"discounted_cash":11.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEMANTINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-298-09","type":"NDC"}],"standard_charges":[{"gross_charge":19.55,"discounted_cash":11.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-329-54","type":"NDC"}],"standard_charges":[{"gross_charge":96.75,"discounted_cash":58.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-405-30","type":"NDC"}],"standard_charges":[{"gross_charge":581.55,"discounted_cash":348.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-033-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.03,"discounted_cash":17.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.24,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUMAZENIL 0.5 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"36000-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.27,"discounted_cash":22.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"38779-0146-1","type":"NDC"}],"standard_charges":[{"gross_charge":29.5,"discounted_cash":17.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM PHOSPHATE DIBASIC POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"38779-0807-8","type":"NDC"}],"standard_charges":[{"gross_charge":23.65,"discounted_cash":14.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALACYCLOVIR HCL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"31722-704-30","type":"NDC"}],"standard_charges":[{"gross_charge":20.41,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALLOPURINOL 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-350-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-189-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.4,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-673-77","type":"NDC"}],"standard_charges":[{"gross_charge":22.96,"discounted_cash":13.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-685-10","type":"NDC"}],"standard_charges":[{"gross_charge":36.17,"discounted_cash":21.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-791-20","type":"NDC"}],"standard_charges":[{"gross_charge":144.19,"discounted_cash":86.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BIO-K PLUS STRONG PO CAP-DEL-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"26608-00118","type":"NDC"}],"standard_charges":[{"gross_charge":10.2,"discounted_cash":6.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BIO-K PLUS STRONG PO CAP-DEL-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"26608-00154","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-097-06","type":"NDC"}],"standard_charges":[{"gross_charge":20.50,"discounted_cash":12.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-098-09","type":"NDC"}],"standard_charges":[{"gross_charge":23.11,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-099-03","type":"NDC"}],"standard_charges":[{"gross_charge":23.54,"discounted_cash":14.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 125 MG PO CSDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-115-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENOFIBRATE 54 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-116-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENOFIBRATE 160 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-117-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.72,"discounted_cash":5.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RANOLAZINE ER 500 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-125-02","type":"NDC"}],"standard_charges":[{"gross_charge":20.45,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-139-09","type":"NDC"}],"standard_charges":[{"gross_charge":13.54,"discounted_cash":8.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-155-04","type":"NDC"}],"standard_charges":[{"gross_charge":11.28,"discounted_cash":6.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE ER 10 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-156-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.7,"discounted_cash":7.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXEPIN HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27241-168-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.42,"discounted_cash":2.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 2.5-6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-187-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIZANIDINE HCL 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-169-15","type":"NDC"}],"standard_charges":[{"gross_charge":8.12,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL FUMARATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-126-13","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":11.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DISTILLED WATER PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"38779-0946-8","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.69,"discounted_cash":14.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.47,"discounted_cash":15.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":26.5,"discounted_cash":15.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCOD POLI-CHLORPHE POLI ER 10-8 MG/5ML PO SUER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-086-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":7.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE-CODEINE 6.25-10 MG/5ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-065-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.33,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-037-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.20,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISPERIDONE 1 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":6.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-156-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":15.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24385-471-78","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-024-05","type":"NDC"}],"standard_charges":[{"gross_charge":44.2,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM HYPOCHLORITE 0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-062-50","type":"NDC"}],"standard_charges":[{"gross_charge":67.18,"discounted_cash":40.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIOTHYRONINE SODIUM 5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42794-018-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIOTHYRONINE SODIUM 25 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42794-019-12","type":"NDC"}],"standard_charges":[{"gross_charge":6.52,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OPIUM 10 MG/ML (1%) PO TINC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42799-217-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":19.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOPERAMIDE HCL 2 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42799-605-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IVERMECTIN 3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42799-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.26,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTRADIOL 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42806-087-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTRADIOL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42806-088-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":2.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHOLESTYRAMINE LIGHT 4 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42806-269-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.85,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHOLESTYRAMINE LIGHT 4 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42806-270-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.82,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-001-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.50,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-301-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.30,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIOTHYRONINE SODIUM 5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42794-018-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 15 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-801-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-802-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DRONABINOL 2.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-867-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.38,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43066-031-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.65,"discounted_cash":32.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43386-090-19","type":"NDC"}],"standard_charges":[{"gross_charge":101.7,"discounted_cash":61.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":99.99,"discounted_cash":59.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORPHENADRINE CITRATE ER 100 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43386-480-24","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DONEPEZIL HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-276-03","type":"NDC"}],"standard_charges":[{"gross_charge":25.8,"discounted_cash":15.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-280-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.3,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISPERIDONE 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-339-06","type":"NDC"}],"standard_charges":[{"gross_charge":14.15,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISPERIDONE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-340-06","type":"NDC"}],"standard_charges":[{"gross_charge":13.07,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VORICONAZOLE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-378-03","type":"NDC"}],"standard_charges":[{"gross_charge":127.3,"discounted_cash":76.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"43547-399-50","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-304-16","type":"NDC"}],"standard_charges":[{"gross_charge":7.50,"discounted_cash":4.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOBAZAM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42571-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.31,"discounted_cash":28.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN HCL 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42571-251-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DAKINS (1/2 STRENGTH) 0.25 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-063-25","type":"NDC"}],"standard_charges":[{"gross_charge":66.3,"discounted_cash":39.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":66.33,"discounted_cash":39.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM HYPOCHLORITE 0.125 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-064-12","type":"NDC"}],"standard_charges":[{"gross_charge":67.51,"discounted_cash":40.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"K PHOS MONO-SOD PHOS DI & MONO 155-852-130 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.58,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-530-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.91,"discounted_cash":8.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-530-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.15,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIOTHYRONINE SODIUM 10 MCG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39822-0151-1","type":"NDC"}],"standard_charges":[{"gross_charge":878.7,"discounted_cash":527.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39822-1000-1","type":"NDC"}],"standard_charges":[{"gross_charge":32.44,"discounted_cash":19.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MULTIVITAMIN-MINERALS PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"40985-22368","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.73,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENGAY GREASELESS 10-15 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"41167-06003","type":"NDC"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42571-137-26","type":"NDC"}],"standard_charges":[{"gross_charge":541.1,"discounted_cash":324.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42494-450-20","type":"NDC"}],"standard_charges":[{"gross_charge":79.30,"discounted_cash":47.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RANOLAZINE ER 500 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42291-773-60","type":"NDC"}],"standard_charges":[{"gross_charge":19.56,"discounted_cash":11.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42192-608-16","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":13.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42192-339-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THYROID 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42192-330-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-024-55","type":"NDC"}],"standard_charges":[{"gross_charge":44.19,"discounted_cash":26.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THYROID 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42192-329-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.57,"discounted_cash":3.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-216-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.9,"discounted_cash":41.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-113-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.43,"discounted_cash":21.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.54,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOHEXITAL SODIUM 100 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-0105-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.42,"discounted_cash":20.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GNP MUSCLE RUB 10-15 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"41167-06006","type":"NDC"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPHEDRINE SULFATE (PRESSORS) 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42023-243-01","type":"NDC"}],"standard_charges":[{"gross_charge":109.70,"discounted_cash":65.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-447-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1520-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1216-89","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUMAZENIL 0.5 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9784-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.85,"discounted_cash":19.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9785-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.80,"discounted_cash":28.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9785-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.29,"discounted_cash":29.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRILAT 1.25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9786-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.18,"discounted_cash":31.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRILAT 1.25 MG/ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9787-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.09,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":40.8,"discounted_cash":24.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN V POTASSIUM 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9837-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN 400 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9887-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"01490-03942","type":"NDC"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0168-0062-02","type":"NDC"}],"standard_charges":[{"gross_charge":31.6,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0168-0099-15","type":"NDC"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":59.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0168-0258-46","type":"NDC"}],"standard_charges":[{"gross_charge":129.9,"discounted_cash":77.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9660-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.26,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ADAPALENE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0168-0424-46","type":"NDC"}],"standard_charges":[{"gross_charge":743.3,"discounted_cash":445.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMOTRIGINE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0173-0642-55","type":"NDC"}],"standard_charges":[{"gross_charge":37.01,"discounted_cash":22.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUTICASONE-UMECLIDIN-VILANT 100-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0173-0887-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.65,"discounted_cash":33.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0182-0905-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAZODONE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0182-1259-89","type":"NDC"}],"standard_charges":[{"gross_charge":4.28,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0185-0010-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0185-0122-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHOLESTYRAMINE 4 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0185-0940-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0186-0370-20","type":"NDC"}],"standard_charges":[{"gross_charge":14.89,"discounted_cash":8.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0186-0372-20","type":"NDC"}],"standard_charges":[{"gross_charge":37.89,"discounted_cash":22.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TICAGRELOR 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0186-0776-60","type":"NDC"}],"standard_charges":[{"gross_charge":27.16,"discounted_cash":16.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TICAGRELOR 45 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0186-0777-39","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":9.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":26.60,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL 0.25 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0225-0800-47","type":"NDC"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":18.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL 0.5 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0225-0805-47","type":"NDC"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":18.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0172-2083-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPRAZOLAM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2027-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9532-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.45,"discounted_cash":39.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9508-10","type":"NDC"}],"standard_charges":[{"gross_charge":43.55,"discounted_cash":26.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1154-30","type":"NDC"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":5.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1276-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.95,"discounted_cash":15.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.36,"discounted_cash":6.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1488-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.71,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1488-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.88,"discounted_cash":5.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1576-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.68,"discounted_cash":8.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1761-30","type":"NDC"}],"standard_charges":[{"gross_charge":13.18,"discounted_cash":7.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1781-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1971-00","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1971-21","type":"NDC"}],"standard_charges":[{"gross_charge":10.60,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-2316-15","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-2316-50","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":9.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-4675-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.37,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-4675-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.73,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.55,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9525-01","type":"NDC"}],"standard_charges":[{"gross_charge":144.25,"discounted_cash":86.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-4950-40","type":"NDC"}],"standard_charges":[{"gross_charge":22.95,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0131-2477-60","type":"NDC"}],"standard_charges":[{"gross_charge":41.68,"discounted_cash":25.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN (LAXATIVE) 2 G RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0132-0079-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.89,"discounted_cash":2.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLEET ENEMA 7-19 GM/118ML RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0132-0201-40","type":"NDC"}],"standard_charges":[{"gross_charge":9.27,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLEET PEDIATRIC 3.5-9.5 GM/59ML RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0132-0202-20","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":5.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DISTILLED WATER PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71091-00006","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINERAL OIL RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0132-0301-40","type":"NDC"}],"standard_charges":[{"gross_charge":13.1,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCOSANOL 10 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0135-0200-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.2,"discounted_cash":59.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 125 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-1240-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.45,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 250 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-1241-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.87,"discounted_cash":5.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN OPHTHALMIC 1 MG/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9262-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9506-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.65,"discounted_cash":18.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9508-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.91,"discounted_cash":18.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-4721-05","type":"NDC"}],"standard_charges":[{"gross_charge":17.95,"discounted_cash":10.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPRAZOLAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2029-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.69,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TEMAZEPAM 15 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2076-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.12,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2620-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0047-47","type":"NDC"}],"standard_charges":[{"gross_charge":109.1,"discounted_cash":65.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0048-02","type":"NDC"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":27.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0048-03","type":"NDC"}],"standard_charges":[{"gross_charge":59.59,"discounted_cash":35.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0048-04","type":"NDC"}],"standard_charges":[{"gross_charge":59.43,"discounted_cash":35.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0051-44","type":"NDC"}],"standard_charges":[{"gross_charge":355.65,"discounted_cash":213.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NOREPINEPHRINE-DEXTROSE 8-5 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0108-20","type":"NDC"}],"standard_charges":[{"gross_charge":147.83,"discounted_cash":88.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN REGULAR(HUMAN) IN NACL 100-0.9 UT/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0126-12","type":"NDC"}],"standard_charges":[{"gross_charge":153.05,"discounted_cash":91.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARDIOPLEGIA DEL NIDO FORMULA PF SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0221-04","type":"NDC"}],"standard_charges":[{"gross_charge":51.13,"discounted_cash":30.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":63.21,"discounted_cash":37.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETIC ACID 0.25 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0656-04","type":"NDC"}],"standard_charges":[{"gross_charge":74.95,"discounted_cash":44.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN WITH ADDITIVES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1099-04","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX PPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1113-04","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1125-04","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX PPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-7024-01","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0047-44","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-7032-01","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-9557-12","type":"NDC"}],"standard_charges":[{"gross_charge":128.33,"discounted_cash":77.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PLASMA-LYTE 148 IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-9593-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.38,"discounted_cash":37.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-0018-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-0018-91","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORTHALIDONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-0213-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-0327-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.52,"discounted_cash":3.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTRADIOL 0.05 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-3350-99","type":"NDC"}],"standard_charges":[{"gross_charge":61.3,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTRADIOL 0.1 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-3352-99","type":"NDC"}],"standard_charges":[{"gross_charge":61.3,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MERCAPTOPURINE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-3547-52","type":"NDC"}],"standard_charges":[{"gross_charge":14.65,"discounted_cash":8.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CETIRIZINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-3635-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.67,"discounted_cash":5.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEVIRAPINE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-4050-91","type":"NDC"}],"standard_charges":[{"gross_charge":31.1,"discounted_cash":18.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL ER 120 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-6320-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-6982-88","type":"NDC"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":25.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-6985-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-7036-01","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0013-04","type":"NDC"}],"standard_charges":[{"gross_charge":27.65,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0004-04","type":"NDC"}],"standard_charges":[{"gross_charge":59.1,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0004-03","type":"NDC"}],"standard_charges":[{"gross_charge":52.3,"discounted_cash":31.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2631-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.26,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2857-09","type":"NDC"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":15.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPRENORPHINE HCL 8 MG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-3153-03","type":"NDC"}],"standard_charges":[{"gross_charge":25.3,"discounted_cash":15.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 100 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-4323-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.1,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0234-0575-04","type":"NDC"}],"standard_charges":[{"gross_charge":30.15,"discounted_cash":18.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOTALOL HCL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-0012-89","type":"NDC"}],"standard_charges":[{"gross_charge":11.0,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-0144-89","type":"NDC"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":13.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-0147-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.38,"discounted_cash":14.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-0147-89","type":"NDC"}],"standard_charges":[{"gross_charge":24.05,"discounted_cash":14.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-0360-89","type":"NDC"}],"standard_charges":[{"gross_charge":29.32,"discounted_cash":17.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 10 MEQ PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-5317-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 10 MEQ PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-5317-89","type":"NDC"}],"standard_charges":[{"gross_charge":5.18,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-5319-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.97,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-5319-89","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM BICARBONATE 25 MEQ PO TBEF","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-5326-30","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0254-1011-96","type":"NDC"}],"standard_charges":[{"gross_charge":19.3,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0264-2201-00","type":"NDC"}],"standard_charges":[{"gross_charge":60.24,"discounted_cash":36.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0004-02","type":"NDC"}],"standard_charges":[{"gross_charge":50.90,"discounted_cash":30.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0316-0232-25","type":"NDC"}],"standard_charges":[{"gross_charge":40.65,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0316-0231-25","type":"NDC"}],"standard_charges":[{"gross_charge":38.21,"discounted_cash":22.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-7372-20","type":"NDC"}],"standard_charges":[{"gross_charge":44.28,"discounted_cash":26.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-7370-20","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXEGOL OXALATE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-1970-30","type":"NDC"}],"standard_charges":[{"gross_charge":39.35,"discounted_cash":23.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1045-16","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-1110-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.56,"discounted_cash":48.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-0275-39","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROFLUMILAST 250 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-0095-39","type":"NDC"}],"standard_charges":[{"gross_charge":38.74,"discounted_cash":23.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZOCAINE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0283-0610-43","type":"NDC"}],"standard_charges":[{"gross_charge":59.95,"discounted_cash":35.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 2 % TD OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0281-0326-08","type":"NDC"}],"standard_charges":[{"gross_charge":9.50,"discounted_cash":5.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETIC ACID 0.25 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0264-2304-00","type":"NDC"}],"standard_charges":[{"gross_charge":73.32,"discounted_cash":43.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0264-2201-10","type":"NDC"}],"standard_charges":[{"gross_charge":58.14,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0310-0755-90","type":"NDC"}],"standard_charges":[{"gross_charge":31.65,"discounted_cash":18.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0970-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.77,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCUSATE SODIUM 50 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0935-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0236-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0386-63","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RUFINAMIDE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0425-23","type":"NDC"}],"standard_charges":[{"gross_charge":32.17,"discounted_cash":19.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHADONE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0709-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.83,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHADONE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0710-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0742-87","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITRIOL 1 MCG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-3120-41","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-3500-49","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":9.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-3532-44","type":"NDC"}],"standard_charges":[{"gross_charge":15.48,"discounted_cash":9.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOTRIMAZOLE 10 MG MT TROC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-4146-22","type":"NDC"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":7.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8297-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.88,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8299-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM CARBONATE 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8526-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.79,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0235-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.20,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM CARBONATE 300 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8527-25","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0056-0176-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCOSE 40 % PO GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"00574-06915","type":"NDC"}],"standard_charges":[{"gross_charge":25.15,"discounted_cash":15.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBACHOL 0.01 % IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0023-15","type":"NDC"}],"standard_charges":[{"gross_charge":155.67,"discounted_cash":93.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0085-15","type":"NDC"}],"standard_charges":[{"gross_charge":43.4,"discounted_cash":26.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0741-14","type":"NDC"}],"standard_charges":[{"gross_charge":62.62,"discounted_cash":37.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0795-15","type":"NDC"}],"standard_charges":[{"gross_charge":47.42,"discounted_cash":28.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BSS PLUS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0800-94","type":"NDC"}],"standard_charges":[{"gross_charge":300.65,"discounted_cash":180.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0817-02","type":"NDC"}],"standard_charges":[{"gross_charge":139.9,"discounted_cash":83.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-1795-04","type":"NDC"}],"standard_charges":[{"gross_charge":127.84,"discounted_cash":76.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0067-8152-03","type":"NDC"}],"standard_charges":[{"gross_charge":81.94,"discounted_cash":49.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIRMATRELVIR&RITONAVIR 150/100 10 X 150 MG & 10 X 100MG PO TBPK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-5317-02","type":"NDC"}],"standard_charges":[{"gross_charge":4278.5,"discounted_cash":2567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIRMATRELVIR&RITONAVIR 300/100 20 X 150 MG & 10 X 100MG PO TBPK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-5321-03","type":"NDC"}],"standard_charges":[{"gross_charge":189.47,"discounted_cash":113.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIRMATRELVIR&RITONAVIR 300/100 20 X 150 MG & 10 X 100MG PO TBPK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-5321-30","type":"NDC"}],"standard_charges":[{"gross_charge":142.61,"discounted_cash":85.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATORVASTATIN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0071-0155-40","type":"NDC"}],"standard_charges":[{"gross_charge":42.6,"discounted_cash":25.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0056-0169-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 7.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0235-24","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.14,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0064-47","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":23.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BARICITINIB 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-4182-30","type":"NDC"}],"standard_charges":[{"gross_charge":272.2,"discounted_cash":163.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":270.26,"discounted_cash":162.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"APIXABAN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0003-0893-31","type":"NDC"}],"standard_charges":[{"gross_charge":33.60,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"APIXABAN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0003-0894-31","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":19.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":33.60,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0004-0058-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RALTEGRAVIR POTASSIUM 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0006-0227-61","type":"NDC"}],"standard_charges":[{"gross_charge":106.35,"discounted_cash":63.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0006-4827-01","type":"NDC"}],"standard_charges":[{"gross_charge":563.05,"discounted_cash":337.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":547.18,"discounted_cash":328.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUGAMMADEX SODIUM 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0006-5423-02","type":"NDC"}],"standard_charges":[{"gross_charge":348.12,"discounted_cash":208.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUGAMMADEX SODIUM 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0006-5423-12","type":"NDC"}],"standard_charges":[{"gross_charge":415.67,"discounted_cash":249.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EXEMESTANE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0009-7663-04","type":"NDC"}],"standard_charges":[{"gross_charge":117.05,"discounted_cash":70.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIFABUTIN 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0013-5301-17","type":"NDC"}],"standard_charges":[{"gross_charge":61.65,"discounted_cash":36.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARTIFICIAL TEARS 83-15 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0023-0240-04","type":"NDC"}],"standard_charges":[{"gross_charge":48.75,"discounted_cash":29.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0046-41","type":"NDC"}],"standard_charges":[{"gross_charge":257.25,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLECAINIDE ACETATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0010-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLECAINIDE ACETATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-0010-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.68,"discounted_cash":4.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE 40 MG/ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0049-3450-19","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTROGENS CONJUGATED 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0046-1104-81","type":"NDC"}],"standard_charges":[{"gross_charge":24.9,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTROGENS CONJUGATED 0.625 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0046-1102-81","type":"NDC"}],"standard_charges":[{"gross_charge":24.9,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 37.5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0074-5182-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.25,"discounted_cash":5.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTROGENS CONJUGATED 0.3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0046-1100-81","type":"NDC"}],"standard_charges":[{"gross_charge":24.9,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 6000-19000 UNITS PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0032-1206-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.24,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 12000-38000 UNITS PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0032-0047-70","type":"NDC"}],"standard_charges":[{"gross_charge":14.13,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 6000-19000 UNITS PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0032-0046-70","type":"NDC"}],"standard_charges":[{"gross_charge":9.66,"discounted_cash":5.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MISOPROSTOL 25 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0025-1451-60","type":"NDC"}],"standard_charges":[{"gross_charge":16.35,"discounted_cash":9.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DRONEDARONE HCL 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0024-4142-60","type":"NDC"}],"standard_charges":[{"gross_charge":43.89,"discounted_cash":26.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":43.6,"discounted_cash":26.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 12000-38000 UNITS PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0032-1212-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.84,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-6993-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.84,"discounted_cash":12.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENTACAPONE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0327-05","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":16.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 4.6 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0501-61","type":"NDC"}],"standard_charges":[{"gross_charge":71.6,"discounted_cash":42.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FINASTERIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-7355-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-7364-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYBURIDE MICRONIZED 3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-8035-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYBURIDE 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-8343-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 10-100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-9701-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPYRIDAMOLE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0115-1070-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SEVELAMER CARBONATE 0.8 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0115-1365-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.03,"discounted_cash":29.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0115-1696-06","type":"NDC"}],"standard_charges":[{"gross_charge":5.40,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPHENIDATE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0115-1800-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLESTIPOL HCL 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0115-5211-16","type":"NDC"}],"standard_charges":[{"gross_charge":7.57,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0116-1060-32","type":"NDC"}],"standard_charges":[{"gross_charge":316.85,"discounted_cash":190.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0116-1061-04","type":"NDC"}],"standard_charges":[{"gross_charge":31.15,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0116-1061-16","type":"NDC"}],"standard_charges":[{"gross_charge":55.9,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0116-2001-04","type":"NDC"}],"standard_charges":[{"gross_charge":28.17,"discounted_cash":16.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-7202-98","type":"NDC"}],"standard_charges":[{"gross_charge":15.83,"discounted_cash":9.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0116-2001-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0431-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.77,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0581-04","type":"NDC"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0595-16","type":"NDC"}],"standard_charges":[{"gross_charge":8.13,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0646-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.09,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0770-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0770-89","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0854-16","type":"NDC"}],"standard_charges":[{"gross_charge":18.10,"discounted_cash":10.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0867-20","type":"NDC"}],"standard_charges":[{"gross_charge":80.16,"discounted_cash":48.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0868-00","type":"NDC"}],"standard_charges":[{"gross_charge":10.84,"discounted_cash":6.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0868-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0873-16","type":"NDC"}],"standard_charges":[{"gross_charge":58.95,"discounted_cash":35.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0873-32","type":"NDC"}],"standard_charges":[{"gross_charge":31.04,"discounted_cash":18.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0903-15","type":"NDC"}],"standard_charges":[{"gross_charge":16.9,"discounted_cash":10.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE-CODEINE 6.25-10 MG/5ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0928-16","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0116-4005-30","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-7201-98","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":6.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MESALAMINE 400 MG PO CAP-DEL-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-5907-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.83,"discounted_cash":7.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN BASE 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-5571-56","type":"NDC"}],"standard_charges":[{"gross_charge":33.75,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARTEMETHER-LUMEFANTRINE 20-120 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0568-45","type":"NDC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":10.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SACUBITRIL-VALSARTAN 12-13 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0659-20","type":"NDC"}],"standard_charges":[{"gross_charge":38.65,"discounted_cash":23.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":38.66,"discounted_cash":23.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SACUBITRIL-VALSARTAN 97-103 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0696-20","type":"NDC"}],"standard_charges":[{"gross_charge":38.67,"discounted_cash":23.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SACUBITRIL-VALSARTAN 49-51 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0777-20","type":"NDC"}],"standard_charges":[{"gross_charge":38.74,"discounted_cash":23.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN 0.3 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0813-01","type":"NDC"}],"standard_charges":[{"gross_charge":803.98,"discounted_cash":482.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0876-01","type":"NDC"}],"standard_charges":[{"gross_charge":872.17,"discounted_cash":523.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN GLARGINE 100 UNIT/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0088-2220-33","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAPROXEN 125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-0147-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.39,"discounted_cash":3.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-0199-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.27,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-0832-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.32,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-0832-93","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOTALOL HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-1061-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.68,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.14,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN SULFATE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-1177-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.92,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 200 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-2026-31","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYZINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-5060-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-4177-74","type":"NDC"}],"standard_charges":[{"gross_charge":12.62,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-4148-45","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAZOSIN HCL 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-4067-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-3213-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-3212-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN 300 MG/5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0078-0494-71","type":"NDC"}],"standard_charges":[{"gross_charge":435.45,"discounted_cash":261.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-3174-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARMODAFINIL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-3090-56","type":"NDC"}],"standard_charges":[{"gross_charge":19.84,"discounted_cash":11.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RASAGILINE MESYLATE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-3060-56","type":"NDC"}],"standard_charges":[{"gross_charge":63.35,"discounted_cash":38.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-2204-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-2203-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-2203-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CILOSTAZOL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-2064-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.10,"discounted_cash":5.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICLOXACILLIN SODIUM 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-3123-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1520-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-6993-93","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9102-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0548-9502-00","type":"NDC"}],"standard_charges":[{"gross_charge":613.2,"discounted_cash":367.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0033-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0158-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0159-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.91,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEGESTROL ACETATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0606-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEGESTROL ACETATE 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0607-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.74,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0872-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0573-2883-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOTRIMAZOLE 10 MG MT TROC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0107-70","type":"NDC"}],"standard_charges":[{"gross_charge":8.6,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIOTHYRONINE SODIUM 2.5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0220-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMILORIDE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0292-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORA-PLUS PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0303-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORA-SWEET PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0304-16","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORA-BLEND PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0312-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.44,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLEET ENEMA 7-19 GM/118ML RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-7415-51","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-4024-50","type":"NDC"}],"standard_charges":[{"gross_charge":41.9,"discounted_cash":25.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-4031-05","type":"NDC"}],"standard_charges":[{"gross_charge":246.35,"discounted_cash":147.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-4031-25","type":"NDC"}],"standard_charges":[{"gross_charge":134.7,"discounted_cash":80.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 300 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-7034-12","type":"NDC"}],"standard_charges":[{"gross_charge":8.19,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-7050-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISACODYL 10 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-7050-50","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-7226-12","type":"NDC"}],"standard_charges":[{"gross_charge":35.35,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-0240-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.21,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-0343-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL 120 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-0345-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-0404-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALVIMOPAN 12 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-2312-45","type":"NDC"}],"standard_charges":[{"gross_charge":486.55,"discounted_cash":291.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLCHICINE 0.6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-2562-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":14.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL ER 120 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-2880-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.16,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KERR INSTA-CHAR IN SORBITOL 50 GM/240ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0520-76","type":"NDC"}],"standard_charges":[{"gross_charge":63.5,"discounted_cash":38.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-3508-04","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":51.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THIAMINE HCL 50 MG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-4680-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.67,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-6 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-4406-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.16,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPHETAMINE-DEXTROAMPHET ER 20 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-5513-37","type":"NDC"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1046-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 650 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1047-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.38,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1054-29","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1186-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1202-07","type":"NDC"}],"standard_charges":[{"gross_charge":6.81,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE 4 % EX PTCH","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1202-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIBUCAINE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1211-95","type":"NDC"}],"standard_charges":[{"gross_charge":35.95,"discounted_cash":21.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETRAHYDROZOLINE HCL 0.05 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1217-94","type":"NDC"}],"standard_charges":[{"gross_charge":26.8,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1248-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.92,"discounted_cash":2.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOTIFEN FUMARATE 0.035 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1252-40","type":"NDC"}],"standard_charges":[{"gross_charge":54.65,"discounted_cash":32.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POVIDONE-IODINE 10 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1271-80","type":"NDC"}],"standard_charges":[{"gross_charge":27.3,"discounted_cash":16.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1286-36","type":"NDC"}],"standard_charges":[{"gross_charge":6.10,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE-MINERAL OIL-PET 0.25-14-74.9 % RE OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1288-06","type":"NDC"}],"standard_charges":[{"gross_charge":28.6,"discounted_cash":17.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMETHICONE 40 MG/0.6ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1303-75","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOCUSATE SODIUM 50 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1304-85","type":"NDC"}],"standard_charges":[{"gross_charge":6.11,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1316-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.65,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYVINYL ALCOHOL 1.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1325-94","type":"NDC"}],"standard_charges":[{"gross_charge":36.8,"discounted_cash":22.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE 250-250-65 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1326-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1327-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1342-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.11,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYVINYL ALCOHOL 1.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1408-94","type":"NDC"}],"standard_charges":[{"gross_charge":37.15,"discounted_cash":22.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAPSAICIN 0.025 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-2525-25","type":"NDC"}],"standard_charges":[{"gross_charge":44.55,"discounted_cash":26.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-3029-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.35,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE POLACRILEX 2 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-3029-34","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE POLACRILEX 4 MG MT GUM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-3030-23","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CITRUS CALCIUM/VITAMIN D 200-6.25 MG-MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-3223-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-3508-54","type":"NDC"}],"standard_charges":[{"gross_charge":85.5,"discounted_cash":51.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-3509-54","type":"NDC"}],"standard_charges":[{"gross_charge":140.8,"discounted_cash":84.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NABUMETONE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-3670-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-2020-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-2020-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN 500 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-2613-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3755-75","type":"NDC"}],"standard_charges":[{"gross_charge":59.76,"discounted_cash":35.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3755-95","type":"NDC"}],"standard_charges":[{"gross_charge":59.00,"discounted_cash":35.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-6139-57","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-6186-67","type":"NDC"}],"standard_charges":[{"gross_charge":704.28,"discounted_cash":422.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 4.6 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-7304-58","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 9.5 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-7309-58","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 13.3 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-7313-31","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 13.3 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-7313-58","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARMODAFINIL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-8029-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.52,"discounted_cash":12.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIFLUOPERAZINE HCL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-8032-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARMODAFINIL 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-8037-31","type":"NDC"}],"standard_charges":[{"gross_charge":58.05,"discounted_cash":34.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLARITHROMYCIN 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-1962-60","type":"NDC"}],"standard_charges":[{"gross_charge":19.35,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARMODAFINIL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-8053-31","type":"NDC"}],"standard_charges":[{"gross_charge":58.05,"discounted_cash":34.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROIC ACID 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0310-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.53,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETHANECHOL CHLORIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0510-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":3.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETHANECHOL CHLORIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0511-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.40,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETHANECHOL CHLORIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0511-89","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETHANECHOL CHLORIDE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0512-00","type":"NDC"}],"standard_charges":[{"gross_charge":10.99,"discounted_cash":6.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0540-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUMETANIDE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0541-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.02,"discounted_cash":6.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EXEMESTANE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-0595-30","type":"NDC"}],"standard_charges":[{"gross_charge":54.05,"discounted_cash":32.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1211-89","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.51,"discounted_cash":3.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.11,"discounted_cash":2.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1212-89","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1213-89","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.12,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-8089-26","type":"NDC"}],"standard_charges":[{"gross_charge":20.91,"discounted_cash":12.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE ER 1000-62.5 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-1943-82","type":"NDC"}],"standard_charges":[{"gross_charge":22.9,"discounted_cash":13.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE ER 1000-62.5 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-1943-39","type":"NDC"}],"standard_charges":[{"gross_charge":22.9,"discounted_cash":13.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NADOLOL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-1181-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEMANTINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-3875-45","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PERPHENAZINE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-4101-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIHEXYPHENIDYL HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-5335-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROBENECID 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-5347-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 20-100 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0024-02","type":"NDC"}],"standard_charges":[{"gross_charge":27.65,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIOTROPIUM BROMIDE MONOHYDRATE 2.5 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0100-51","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":7.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINAGLIPTIN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0140-61","type":"NDC"}],"standard_charges":[{"gross_charge":55.9,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMPAGLIFLOZIN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0152-30","type":"NDC"}],"standard_charges":[{"gross_charge":64.3,"discounted_cash":38.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":60.17,"discounted_cash":36.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMPAGLIFLOZIN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0152-37","type":"NDC"}],"standard_charges":[{"gross_charge":65.06,"discounted_cash":39.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMPAGLIFLOZIN 12.5MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0153-37","type":"NDC"}],"standard_charges":[{"gross_charge":41.68,"discounted_cash":25.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":65.25,"discounted_cash":39.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIOTROPIUM BROMIDE-OLODATEROL 2.5-2.5 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0155-61","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIOTROPIUM BROMIDE-OLODATEROL 2.5-2.5 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0155-70","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IDARUCIZUMAB 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0197-05","type":"NDC"}],"standard_charges":[{"gross_charge":7404.58,"discounted_cash":4442.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0355-56","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0360-82","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0713-0683-31","type":"NDC"}],"standard_charges":[{"gross_charge":264.65,"discounted_cash":158.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0713-0683-15","type":"NDC"}],"standard_charges":[{"gross_charge":144.15,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0713-0526-06","type":"NDC"}],"standard_charges":[{"gross_charge":44.76,"discounted_cash":26.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0713-0268-31","type":"NDC"}],"standard_charges":[{"gross_charge":29.55,"discounted_cash":17.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0703-9514-03","type":"NDC"}],"standard_charges":[{"gross_charge":45.87,"discounted_cash":27.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-4593-13","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0703-9514-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.32,"discounted_cash":24.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN WITH ADDITIVES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6261-01","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":48.8,"discounted_cash":29.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6147-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.55,"discounted_cash":24.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL-DEXTROSE 125-5 MG/125ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6015-10","type":"NDC"}],"standard_charges":[{"gross_charge":76.87,"discounted_cash":46.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0603-3079-21","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZTROPINE MESYLATE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0603-2434-21","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZTROPINE MESYLATE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0603-2433-21","type":"NDC"}],"standard_charges":[{"gross_charge":5.37,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-4591-13","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":23.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL ER 80 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-4117-37","type":"NDC"}],"standard_charges":[{"gross_charge":9.58,"discounted_cash":5.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL ER 60 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-4116-37","type":"NDC"}],"standard_charges":[{"gross_charge":8.34,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8003-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.66,"discounted_cash":4.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 15 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8315-23","type":"NDC"}],"standard_charges":[{"gross_charge":8.57,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 15 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8315-62","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8330-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.15,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8515-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8556-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.95,"discounted_cash":5.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 100 MG/5ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8557-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.42,"discounted_cash":13.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPHETAMINE-DEXTROAMPHET ER 20 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8954-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.28,"discounted_cash":11.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-9100-76","type":"NDC"}],"standard_charges":[{"gross_charge":134.9,"discounted_cash":80.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 12 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-9112-76","type":"NDC"}],"standard_charges":[{"gross_charge":53.86,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-9125-76","type":"NDC"}],"standard_charges":[{"gross_charge":39.85,"discounted_cash":23.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-9150-76","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 75 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-9175-76","type":"NDC"}],"standard_charges":[{"gross_charge":102.8,"discounted_cash":61.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1103-01","type":"NDC"}],"standard_charges":[{"gross_charge":815.91,"discounted_cash":489.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1103-11","type":"NDC"}],"standard_charges":[{"gross_charge":813.33,"discounted_cash":488.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1208-11","type":"NDC"}],"standard_charges":[{"gross_charge":68.7,"discounted_cash":41.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1638-02","type":"NDC"}],"standard_charges":[{"gross_charge":26.71,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1638-32","type":"NDC"}],"standard_charges":[{"gross_charge":23.06,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1746-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.7,"discounted_cash":13.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1746-71","type":"NDC"}],"standard_charges":[{"gross_charge":61.35,"discounted_cash":36.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1749-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.32,"discounted_cash":25.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1966-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.35,"discounted_cash":17.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1966-02","type":"NDC"}],"standard_charges":[{"gross_charge":28.08,"discounted_cash":16.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1966-05","type":"NDC"}],"standard_charges":[{"gross_charge":28.5,"discounted_cash":17.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1966-06","type":"NDC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1966-07","type":"NDC"}],"standard_charges":[{"gross_charge":32.05,"discounted_cash":19.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1966-12","type":"NDC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2051-05","type":"NDC"}],"standard_charges":[{"gross_charge":38.56,"discounted_cash":23.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1208-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.42,"discounted_cash":55.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8003-12","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHADONE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-5771-23","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHADONE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-5771-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.2 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9104-93","type":"NDC"}],"standard_charges":[{"gross_charge":9.3,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9112-93","type":"NDC"}],"standard_charges":[{"gross_charge":9.95,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 12 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9119-16","type":"NDC"}],"standard_charges":[{"gross_charge":53.27,"discounted_cash":31.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 25 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9121-16","type":"NDC"}],"standard_charges":[{"gross_charge":39.85,"discounted_cash":23.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9122-16","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 75 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9123-16","type":"NDC"}],"standard_charges":[{"gross_charge":102.8,"discounted_cash":61.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9124-16","type":"NDC"}],"standard_charges":[{"gross_charge":134.9,"discounted_cash":80.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9671-31","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":6.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0395-1031-96","type":"NDC"}],"standard_charges":[{"gross_charge":9.38,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMPLE SYRUP PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0395-2661-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHERRY PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0395-2662-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0123-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0123-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 2.5-162.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0123-23","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.69,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0123-62","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0124-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-3243-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":2.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.38,"discounted_cash":2.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-1236-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALTREXONE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-1170-03","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPHENIDATE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-1142-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0552-23","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2051-15","type":"NDC"}],"standard_charges":[{"gross_charge":47.04,"discounted_cash":28.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0552-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0523-23","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0512-23","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0512-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.00,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0484-62","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0484-23","type":"NDC"}],"standard_charges":[{"gross_charge":5.98,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0124-23","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHADONE HCL 10 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-0527-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.60,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 4.6 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9070-16","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL-NACL 30-0.9 MG/30ML-% IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2634-05","type":"NDC"}],"standard_charges":[{"gross_charge":58.2,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-9003-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-9003-60","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-9501-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-9701-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-9801-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-9901-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":1.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.72,"discounted_cash":1.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-6710-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.78,"discounted_cash":41.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-6710-10","type":"NDC"}],"standard_charges":[{"gross_charge":64.52,"discounted_cash":38.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-9305-01","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-9305-25","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RACEPINEPHRINE HCL 2.25 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-5901-99","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRIMIDONE 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-1231-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRIMIDONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-1301-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.38,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METAXALONE 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-1435-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.3,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN 25 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-1948-68","type":"NDC"}],"standard_charges":[{"gross_charge":231.51,"discounted_cash":138.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 25 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-3280-46","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-3281-46","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-3283-46","type":"NDC"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-3285-46","type":"NDC"}],"standard_charges":[{"gross_charge":6.19,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.3,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 125 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-3286-46","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 150 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-3288-46","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 175 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0527-3289-46","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RACEPINEPHRINE HCL 2.25 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-2784-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":5.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0487-0201-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.05,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLBETUXIMAB-CLZB 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0469-3425-10","type":"NDC"}],"standard_charges":[{"gross_charge":4688.55,"discounted_cash":2813.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4887-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.84,"discounted_cash":13.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4887-17","type":"NDC"}],"standard_charges":[{"gross_charge":27.88,"discounted_cash":16.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4887-23","type":"NDC"}],"standard_charges":[{"gross_charge":20.89,"discounted_cash":12.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4887-24","type":"NDC"}],"standard_charges":[{"gross_charge":29.53,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4887-25","type":"NDC"}],"standard_charges":[{"gross_charge":28.94,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4888-02","type":"NDC"}],"standard_charges":[{"gross_charge":19.42,"discounted_cash":11.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4888-03","type":"NDC"}],"standard_charges":[{"gross_charge":28.51,"discounted_cash":17.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4888-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.70,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4888-20","type":"NDC"}],"standard_charges":[{"gross_charge":27.71,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-4900-14","type":"NDC"}],"standard_charges":[{"gross_charge":96.87,"discounted_cash":58.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-6648-02","type":"NDC"}],"standard_charges":[{"gross_charge":63.91,"discounted_cash":38.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THYROID 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0456-0458-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0440-7321-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MOI-STIR MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"04369-60042","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":29.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE 1500 MCG/30ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9094-61","type":"NDC"}],"standard_charges":[{"gross_charge":58.65,"discounted_cash":35.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN WITH ADDITIVES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-8183-11","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-7391-82","type":"NDC"}],"standard_charges":[{"gross_charge":61.00,"discounted_cash":36.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":54.18,"discounted_cash":32.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-7295-11","type":"NDC"}],"standard_charges":[{"gross_charge":50.63,"discounted_cash":30.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":60.81,"discounted_cash":36.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-7295-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.52,"discounted_cash":30.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":64.95,"discounted_cash":38.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-7083-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.45,"discounted_cash":47.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROSE 50 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-6648-16","type":"NDC"}],"standard_charges":[{"gross_charge":54.03,"discounted_cash":32.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LETROZOLE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-476-11","type":"NDC"}],"standard_charges":[{"gross_charge":48.7,"discounted_cash":29.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-411-12","type":"NDC"}],"standard_charges":[{"gross_charge":39.85,"discounted_cash":23.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-504-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.20,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-732-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.9,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GALANTAMINE HYDROBROMIDE ER 8 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-744-30","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":11.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-760-90","type":"NDC"}],"standard_charges":[{"gross_charge":23.79,"discounted_cash":14.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARMODAFINIL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-805-30","type":"NDC"}],"standard_charges":[{"gross_charge":20.86,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARMODAFINIL 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-806-30","type":"NDC"}],"standard_charges":[{"gross_charge":58.05,"discounted_cash":34.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARMODAFINIL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-807-30","type":"NDC"}],"standard_charges":[{"gross_charge":58.05,"discounted_cash":34.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRASUGREL HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-830-30","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":24.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOZAPINE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-845-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.63,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-896-78","type":"NDC"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":25.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66553-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 81 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66553-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":2.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EZETIMIBE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66582-414-29","type":"NDC"}],"standard_charges":[{"gross_charge":38.35,"discounted_cash":23.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66685-1001-0","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66689-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFUROXIME AXETIL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-699-60","type":"NDC"}],"standard_charges":[{"gross_charge":13.85,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66689-023-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.08,"discounted_cash":7.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 0.05 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66689-327-02","type":"NDC"}],"standard_charges":[{"gross_charge":28.18,"discounted_cash":16.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66794-230-02","type":"NDC"}],"standard_charges":[{"gross_charge":22.14,"discounted_cash":13.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66794-230-42","type":"NDC"}],"standard_charges":[{"gross_charge":21.33,"discounted_cash":12.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RADIAPLEXRX EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66977-106-06","type":"NDC"}],"standard_charges":[{"gross_charge":87.48,"discounted_cash":52.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66993-019-68","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 7.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66993-606-30","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":6.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASCORBIC ACID 25000 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67157-101-50","type":"NDC"}],"standard_charges":[{"gross_charge":843.15,"discounted_cash":505.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM TETRADECYL SULFATE 3 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-163-02","type":"NDC"}],"standard_charges":[{"gross_charge":249.39,"discounted_cash":149.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-839-02","type":"NDC"}],"standard_charges":[{"gross_charge":817.4,"discounted_cash":490.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-852-00","type":"NDC"}],"standard_charges":[{"gross_charge":57.06,"discounted_cash":34.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67618-200-32","type":"NDC"}],"standard_charges":[{"gross_charge":69.8,"discounted_cash":41.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETHIODIZED OIL 480 MG/ML IJ OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67684-1901-2","type":"NDC"}],"standard_charges":[{"gross_charge":3607.26,"discounted_cash":2164.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67777-220-07","type":"NDC"}],"standard_charges":[{"gross_charge":81.70,"discounted_cash":49.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHARCOAL ACTIVATED PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66689-201-08","type":"NDC"}],"standard_charges":[{"gross_charge":68.48,"discounted_cash":41.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLIDOCANOL 0.5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67850-140-00","type":"NDC"}],"standard_charges":[{"gross_charge":74.13,"discounted_cash":44.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL ER 150 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-697-90","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":9.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPRAZOLAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-677-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.61,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-126-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-127-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-146-36","type":"NDC"}],"standard_charges":[{"gross_charge":70.7,"discounted_cash":42.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-147-36","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FINASTERIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-149-90","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":6.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.02,"discounted_cash":9.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIBAVIRIN 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-207-68","type":"NDC"}],"standard_charges":[{"gross_charge":22.52,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINOCYCLINE HCL 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-209-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINOCYCLINE HCL 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-211-50","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-219-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.19,"discounted_cash":17.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-294-90","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":15.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-295-90","type":"NDC"}],"standard_charges":[{"gross_charge":25.47,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RITONAVIR 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-687-30","type":"NDC"}],"standard_charges":[{"gross_charge":27.25,"discounted_cash":16.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GALANTAMINE HYDROBROMIDE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-458-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-503-20","type":"NDC"}],"standard_charges":[{"gross_charge":17.05,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL ER 37.5 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-527-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.47,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-528-90","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-536-50","type":"NDC"}],"standard_charges":[{"gross_charge":45.7,"discounted_cash":27.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOFLOXACIN 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-537-50","type":"NDC"}],"standard_charges":[{"gross_charge":51.7,"discounted_cash":31.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-595-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.6,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-596-02","type":"NDC"}],"standard_charges":[{"gross_charge":41.99,"discounted_cash":25.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-625-03","type":"NDC"}],"standard_charges":[{"gross_charge":84.27,"discounted_cash":50.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENTACAPONE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-654-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":15.63,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REPAGLINIDE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-670-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REPAGLINIDE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-671-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPRAZOLAM 0.125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-676-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":2.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.43,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-502-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.90,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-124-25","type":"NDC"}],"standard_charges":[{"gross_charge":36.60,"discounted_cash":21.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-124-40","type":"NDC"}],"standard_charges":[{"gross_charge":181.75,"discounted_cash":109.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TEMAZEPAM 15 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFDINIR 300 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-362-06","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":10.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-373-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-385-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.99,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-399-00","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-400-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.03,"discounted_cash":5.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-414-05","type":"NDC"}],"standard_charges":[{"gross_charge":23.8,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAMIPRIL 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-430-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 14 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-433-90","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-438-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.34,"discounted_cash":3.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-438-96","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-438-97","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE HCL 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-450-06","type":"NDC"}],"standard_charges":[{"gross_charge":25.83,"discounted_cash":15.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE HCL 60 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-452-06","type":"NDC"}],"standard_charges":[{"gross_charge":30.82,"discounted_cash":18.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 125 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-472-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.71,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-361-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.45,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-476-46","type":"NDC"}],"standard_charges":[{"gross_charge":30.3,"discounted_cash":18.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-477-47","type":"NDC"}],"standard_charges":[{"gross_charge":26.59,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.02,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-483-45","type":"NDC"}],"standard_charges":[{"gross_charge":39.6,"discounted_cash":23.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-505-55","type":"NDC"}],"standard_charges":[{"gross_charge":43.15,"discounted_cash":25.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-531-46","type":"NDC"}],"standard_charges":[{"gross_charge":21.94,"discounted_cash":13.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-562-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-591-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":7.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-604-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.13,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-014-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PAROXETINE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-045-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.94,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRETINOIN 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-075-11","type":"NDC"}],"standard_charges":[{"gross_charge":75.71,"discounted_cash":45.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-082-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-476-50","type":"NDC"}],"standard_charges":[{"gross_charge":141.05,"discounted_cash":84.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-334-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-333-00","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-332-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.20,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-197-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-251-45","type":"NDC"}],"standard_charges":[{"gross_charge":100.05,"discounted_cash":60.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RILUZOLE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-286-60","type":"NDC"}],"standard_charges":[{"gross_charge":94.85,"discounted_cash":56.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.90,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-419-33","type":"NDC"}],"standard_charges":[{"gross_charge":452.95,"discounted_cash":271.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOLIFENACIN SUCCINATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-527-90","type":"NDC"}],"standard_charges":[{"gross_charge":36.65,"discounted_cash":21.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":35.80,"discounted_cash":21.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOLIFENACIN SUCCINATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-528-90","type":"NDC"}],"standard_charges":[{"gross_charge":36.65,"discounted_cash":21.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORTHALIDONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-696-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.53,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORTHALIDONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-697-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-732-95","type":"NDC"}],"standard_charges":[{"gross_charge":99.39,"discounted_cash":59.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DRONABINOL 2.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-753-60","type":"NDC"}],"standard_charges":[{"gross_charge":20.55,"discounted_cash":12.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":18.22,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67877-756-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-106-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-151-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL 75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-308-00","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-245-14","type":"NDC"}],"standard_charges":[{"gross_charge":18.61,"discounted_cash":11.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZONISAMIDE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-244-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":4.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZONISAMIDE 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-242-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.20,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TERBINAFINE HCL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-079-30","type":"NDC"}],"standard_charges":[{"gross_charge":35.85,"discounted_cash":21.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-195-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.58,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA ER 50-200 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-172-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.3,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-162-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-161-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.19,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-157-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.58,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ANASTROZOLE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-155-04","type":"NDC"}],"standard_charges":[{"gross_charge":37.55,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 3.125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-153-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.85,"discounted_cash":5.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-180-00","type":"NDC"}],"standard_charges":[{"gross_charge":20.59,"discounted_cash":12.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CIPROFLOXACIN HCL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-076-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMVASTATIN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-050-90","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIDOVUDINE 50 MG/5ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-048-24","type":"NDC"}],"standard_charges":[{"gross_charge":22.7,"discounted_cash":13.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZTREONAM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-402-41","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUMAZENIL 0.5 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-424-05","type":"NDC"}],"standard_charges":[{"gross_charge":46.15,"discounted_cash":27.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-426-02","type":"NDC"}],"standard_charges":[{"gross_charge":28.92,"discounted_cash":17.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":41.55,"discounted_cash":24.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROCURONIUM BROMIDE 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-426-10","type":"NDC"}],"standard_charges":[{"gross_charge":56.52,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-462-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.35,"discounted_cash":35.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-462-37","type":"NDC"}],"standard_charges":[{"gross_charge":64.28,"discounted_cash":38.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-468-37","type":"NDC"}],"standard_charges":[{"gross_charge":59.39,"discounted_cash":35.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-481-57","type":"NDC"}],"standard_charges":[{"gross_charge":47.6,"discounted_cash":28.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZTREONAM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-402-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.10,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-489-17","type":"NDC"}],"standard_charges":[{"gross_charge":50.61,"discounted_cash":30.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-489-27","type":"NDC"}],"standard_charges":[{"gross_charge":87.8,"discounted_cash":52.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-07","type":"NDC"}],"standard_charges":[{"gross_charge":60.22,"discounted_cash":36.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-492-26","type":"NDC"}],"standard_charges":[{"gross_charge":32.85,"discounted_cash":19.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-494-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":20.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-494-05","type":"NDC"}],"standard_charges":[{"gross_charge":32.92,"discounted_cash":19.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-494-16","type":"NDC"}],"standard_charges":[{"gross_charge":27.07,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROATE SODIUM 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-494-41","type":"NDC"}],"standard_charges":[{"gross_charge":24.36,"discounted_cash":14.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-488-37","type":"NDC"}],"standard_charges":[{"gross_charge":79.6,"discounted_cash":47.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZTREONAM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-402-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.10,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFOTETAN DISODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-386-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.05,"discounted_cash":84.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-266-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-267-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-734-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.47,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIHEXYPHENIDYL HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-886-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.3,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-984-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-994-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.21,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEXILETINE HCL 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62756-955-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.85,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE-NACL 2.5-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63037-101-05","type":"NDC"}],"standard_charges":[{"gross_charge":144.55,"discounted_cash":86.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL-DEXTROSE 125-5 MG/125ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63037-119-05","type":"NDC"}],"standard_charges":[{"gross_charge":2593.15,"discounted_cash":1555.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63304-451-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63304-773-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-093-01","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-130-02","type":"NDC"}],"standard_charges":[{"gross_charge":103.42,"discounted_cash":62.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAFCILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-328-22","type":"NDC"}],"standard_charges":[{"gross_charge":46.48,"discounted_cash":27.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN OPHTHALMIC 25 MG/0.5 ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-284-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.70,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINERAL OIL LIGHT OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-254-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.77,"discounted_cash":39.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"STERILE WATER FOR INJECTION IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-185-07","type":"NDC"}],"standard_charges":[{"gross_charge":32.88,"discounted_cash":19.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-094-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-739-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.2,"discounted_cash":17.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE ER 10 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":3.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PERPHENAZINE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-291-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.15,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-324-30","type":"NDC"}],"standard_charges":[{"gross_charge":236.75,"discounted_cash":142.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SERTRALINE HCL 20 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-409-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITRIOL 1 MCG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-447-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.56,"discounted_cash":14.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-513-05","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DAPSONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-567-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-033-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.06,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SEVELAMER CARBONATE 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-058-27","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-062-05","type":"NDC"}],"standard_charges":[{"gross_charge":19.35,"discounted_cash":11.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-101-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-212-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILDENAFIL CITRATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-351-09","type":"NDC"}],"standard_charges":[{"gross_charge":53.5,"discounted_cash":32.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":52.47,"discounted_cash":31.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE ER 5 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAMADOL HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-627-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.07,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-649-78","type":"NDC"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":23.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENAZOPYRIDINE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-681-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.36,"discounted_cash":5.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENAZOPYRIDINE HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-682-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-691-79","type":"NDC"}],"standard_charges":[{"gross_charge":40.87,"discounted_cash":24.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATOVAQUONE 750 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-693-88","type":"NDC"}],"standard_charges":[{"gross_charge":127.19,"discounted_cash":76.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN 300 MG/5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65162-914-46","type":"NDC"}],"standard_charges":[{"gross_charge":349.7,"discounted_cash":209.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-184-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.40,"discounted_cash":23.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.69,"discounted_cash":24.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.39,"discounted_cash":29.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-445-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.5,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65219-447-02","type":"NDC"}],"standard_charges":[{"gross_charge":34.53,"discounted_cash":20.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 25 MG/ML PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65628-205-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.06,"discounted_cash":11.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIFAXIMIN 550 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65649-303-03","type":"NDC"}],"standard_charges":[{"gross_charge":168.28,"discounted_cash":100.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE ER 2.5 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64980-279-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64950-362-04","type":"NDC"}],"standard_charges":[{"gross_charge":741.25,"discounted_cash":444.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64950-354-05","type":"NDC"}],"standard_charges":[{"gross_charge":20.36,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-881-01","type":"NDC"}],"standard_charges":[{"gross_charge":87.72,"discounted_cash":52.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":103.34,"discounted_cash":62.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-924-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":18.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-924-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.24,"discounted_cash":17.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":28.71,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-940-04","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":18.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESLICARBAZEPINE ACETATE 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63402-204-30","type":"NDC"}],"standard_charges":[{"gross_charge":131.68,"discounted_cash":79.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PERMETHRIN 1 % EX LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63736-12002","type":"NDC"}],"standard_charges":[{"gross_charge":61.6,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIOCONAZOLE 6.5 % VA OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63736-44101","type":"NDC"}],"standard_charges":[{"gross_charge":80.9,"discounted_cash":48.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-079-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALPROIC ACID 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-086-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-087-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOCARBAMOL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-166-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.7,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 81 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-212-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM OXIDE -MG SUPPLEMENT 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 7.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-355-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64380-971-06","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CINACALCET HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64380-883-04","type":"NDC"}],"standard_charges":[{"gross_charge":77.82,"discounted_cash":46.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64380-797-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":23.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACARBOSE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64380-759-06","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACARBOSE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64380-758-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.85,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITRIOL 0.25 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64380-723-04","type":"NDC"}],"standard_charges":[{"gross_charge":6.68,"discounted_cash":4.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"REMIFENTANIL HCL 2 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-724-05","type":"NDC"}],"standard_charges":[{"gross_charge":403.08,"discounted_cash":241.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHIMAZOLE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64380-212-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-673-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-645-41","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-645-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMVASTATIN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-570-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-486-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 81 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63739-434-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.01,"discounted_cash":2.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHACHOLINE CHLORIDE IN KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"64281-110-05","type":"NDC"}],"standard_charges":[{"gross_charge":400.1,"discounted_cash":240.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-098-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE HCL 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-103-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.19,"discounted_cash":13.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-108-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.47,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-904-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.78,"discounted_cash":3.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-905-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":3.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.45,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69339-151-19","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":4.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69339-152-17","type":"NDC"}],"standard_charges":[{"gross_charge":9.30,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69339-157-05","type":"NDC"}],"standard_charges":[{"gross_charge":20.42,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDOMETHACIN 25 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69344-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":151.85,"discounted_cash":91.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROBIOTIC PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69355-412-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.00,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.25,"discounted_cash":7.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69367-194-30","type":"NDC"}],"standard_charges":[{"gross_charge":71.06,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERGOCALCIFEROL 200 MCG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69367-283-02","type":"NDC"}],"standard_charges":[{"gross_charge":30.95,"discounted_cash":18.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPLERENONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69367-307-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.91,"discounted_cash":7.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.37,"discounted_cash":7.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZONATATE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-143-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.52,"discounted_cash":6.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-151-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-156-74","type":"NDC"}],"standard_charges":[{"gross_charge":83.45,"discounted_cash":50.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIZATRIPTAN BENZOATE 10 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-157-74","type":"NDC"}],"standard_charges":[{"gross_charge":85.8,"discounted_cash":51.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITRIOL 0.25 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-207-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIMODIPINE 30 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-209-07","type":"NDC"}],"standard_charges":[{"gross_charge":50.79,"discounted_cash":30.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-290-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-346-60","type":"NDC"}],"standard_charges":[{"gross_charge":40.92,"discounted_cash":24.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-389-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL 0.25 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69536-025-15","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL 0.5 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69536-050-15","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69543-455-10","type":"NDC"}],"standard_charges":[{"gross_charge":175.26,"discounted_cash":105.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69543-455-20","type":"NDC"}],"standard_charges":[{"gross_charge":168.74,"discounted_cash":101.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARISOPRODOL 350 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69584-111-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.75,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMIPRAMINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69584-426-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MULTIVITAMIN & MINERAL PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69618-00858","type":"NDC"}],"standard_charges":[{"gross_charge":24.20,"discounted_cash":14.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-318-20","type":"NDC"}],"standard_charges":[{"gross_charge":32.56,"discounted_cash":19.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIFEDIPINE 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-211-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.71,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-639-25","type":"NDC"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-639-45","type":"NDC"}],"standard_charges":[{"gross_charge":85.60,"discounted_cash":51.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-679-60","type":"NDC"}],"standard_charges":[{"gross_charge":44.29,"discounted_cash":26.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-940-86","type":"NDC"}],"standard_charges":[{"gross_charge":121.32,"discounted_cash":72.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68682-006-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68682-007-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.40,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68682-007-50","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 90 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68682-008-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIFEDIPINE ER 60 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68682-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.92,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68682-302-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.65,"discounted_cash":4.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRYPAN BLUE 0.06 % IO SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68803-612-10","type":"NDC"}],"standard_charges":[{"gross_charge":261.42,"discounted_cash":156.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DARUNAVIR 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-244-02","type":"NDC"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-579-67","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":149.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-677-05","type":"NDC"}],"standard_charges":[{"gross_charge":19.88,"discounted_cash":11.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-788-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GEMFIBROZIL 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-821-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMIPRAMINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-134-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.08,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-116-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.90,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-2081-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-2078-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-1617-1","type":"NDC"}],"standard_charges":[{"gross_charge":28.25,"discounted_cash":16.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOBAZAM 2.5 MG/ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-1535-2","type":"NDC"}],"standard_charges":[{"gross_charge":112.8,"discounted_cash":67.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69618-027-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-1266-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORPROMAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-1056-1","type":"NDC"}],"standard_charges":[{"gross_charge":23.3,"discounted_cash":13.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORPROMAZINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-1054-1","type":"NDC"}],"standard_charges":[{"gross_charge":13.82,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NABUMETONE 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-966-07","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NABUMETONE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-965-07","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NADOLOL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-868-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.08,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NADOLOL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-867-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":7.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXEPIN HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-1170-9","type":"NDC"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VORICONAZOLE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-573-30","type":"NDC"}],"standard_charges":[{"gross_charge":198.75,"discounted_cash":119.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":197.72,"discounted_cash":118.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPAFENONE HCL ER 225 MG PO CAP-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69680-130-60","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":4.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 0.1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69918-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":9.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-404-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.6,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAZOSIN HCL 2 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-430-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-607-30","type":"NDC"}],"standard_charges":[{"gross_charge":195.3,"discounted_cash":117.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-614-30","type":"NDC"}],"standard_charges":[{"gross_charge":145.65,"discounted_cash":87.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-629-25","type":"NDC"}],"standard_charges":[{"gross_charge":122.75,"discounted_cash":73.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAZOLAMIDE 125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-721-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":6.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.32,"discounted_cash":6.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70860-301-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.62,"discounted_cash":18.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.33,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 125 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70860-301-25","type":"NDC"}],"standard_charges":[{"gross_charge":55.95,"discounted_cash":33.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70860-301-41","type":"NDC"}],"standard_charges":[{"gross_charge":30.38,"discounted_cash":18.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.34,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 125 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70860-301-43","type":"NDC"}],"standard_charges":[{"gross_charge":55.83,"discounted_cash":33.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":54.05,"discounted_cash":32.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CETIRIZINE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70752-104-06","type":"NDC"}],"standard_charges":[{"gross_charge":13.05,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAZOSIN HCL 2 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-020-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.60,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-148-10","type":"NDC"}],"standard_charges":[{"gross_charge":64.18,"discounted_cash":38.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR 200 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":51.45,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIHEXYPHENIDYL HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-212-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.52,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-240-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-258-10","type":"NDC"}],"standard_charges":[{"gross_charge":41.00,"discounted_cash":24.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PAROXETINE HCL 10 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-319-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.74,"discounted_cash":32.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MISOPROSTOL 100 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-443-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.11,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MISOPROSTOL 200 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-444-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRAZINAMIDE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-484-20","type":"NDC"}],"standard_charges":[{"gross_charge":17.65,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-518-10","type":"NDC"}],"standard_charges":[{"gross_charge":177.45,"discounted_cash":106.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIMETHOPRIM 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-541-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTRADIOL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-565-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.30,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIFABUTIN 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70954-041-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":28.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POSACONAZOLE 100 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70748-258-07","type":"NDC"}],"standard_charges":[{"gross_charge":181.92,"discounted_cash":109.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70710-1285-1","type":"NDC"}],"standard_charges":[{"gross_charge":9.23,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70710-1151-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.52,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 0.05 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69918-101-56","type":"NDC"}],"standard_charges":[{"gross_charge":11.1,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70010-149-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.45,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70010-786-12","type":"NDC"}],"standard_charges":[{"gross_charge":177.9,"discounted_cash":106.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-121-01","type":"NDC"}],"standard_charges":[{"gross_charge":110.55,"discounted_cash":66.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOBRAMYCIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-131-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-151-01","type":"NDC"}],"standard_charges":[{"gross_charge":807.57,"discounted_cash":484.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-151-10","type":"NDC"}],"standard_charges":[{"gross_charge":792.35,"discounted_cash":475.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-181-01","type":"NDC"}],"standard_charges":[{"gross_charge":249.95,"discounted_cash":149.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PILOCARPINE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-191-01","type":"NDC"}],"standard_charges":[{"gross_charge":255.1,"discounted_cash":153.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PILOCARPINE HCL 4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":266.3,"discounted_cash":159.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.1,"discounted_cash":32.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-232-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.25,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":255.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-471-01","type":"NDC"}],"standard_charges":[{"gross_charge":194.55,"discounted_cash":116.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM PHOSPHATES 45 MMOLE/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-747-01","type":"NDC"}],"standard_charges":[{"gross_charge":114.17,"discounted_cash":68.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":98.39,"discounted_cash":59.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYPROHEPTADINE HCL 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70710-1110-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70700-268-99","type":"NDC"}],"standard_charges":[{"gross_charge":249.75,"discounted_cash":149.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70700-119-84","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70518-1521-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70518-1353-2","type":"NDC"}],"standard_charges":[{"gross_charge":4.75,"discounted_cash":2.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70518-1353-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.42,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPAFENONE HCL ER 325 MG PO CAP-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69680-131-60","type":"NDC"}],"standard_charges":[{"gross_charge":7.55,"discounted_cash":4.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL ER (SR) 100 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70436-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.86,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70377-061-12","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDOCYANINE GREEN 25 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70100-424-01","type":"NDC"}],"standard_charges":[{"gross_charge":172.87,"discounted_cash":103.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL-DEXTROSE 125-5 MG/125ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70092-1575-36","type":"NDC"}],"standard_charges":[{"gross_charge":118.43,"discounted_cash":71.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOHEXITAL SODIUM 100 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70092-1310-46","type":"NDC"}],"standard_charges":[{"gross_charge":91.59,"discounted_cash":54.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CIT-ROPIVACAINE-NACL 0.2-0.2-0.9 MG/100ML-% EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70092-1108-36","type":"NDC"}],"standard_charges":[{"gross_charge":180.33,"discounted_cash":108.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL-DEXTROSE 125-5 MG/125ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70092-1007-36","type":"NDC"}],"standard_charges":[{"gross_charge":156.7,"discounted_cash":94.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMINOCAPROIC ACID 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70377-102-11","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-265-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.79,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATOVAQUONE 750 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-421-21","type":"NDC"}],"standard_charges":[{"gross_charge":165.7,"discounted_cash":99.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":2.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-354-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.25,"discounted_cash":3.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.57,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZTROPINE MESYLATE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-381-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZTROPINE MESYLATE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-388-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-444-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.31,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-447-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TACROLIMUS 1 MG/ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-451-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-479-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.57,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-494-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.31,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.7,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMVASTATIN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-511-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.82,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMVASTATIN 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-512-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.42,"discounted_cash":9.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-536-11","type":"NDC"}],"standard_charges":[{"gross_charge":21.16,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-347-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.61,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-539-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.40,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TEMAZEPAM 7.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-549-21","type":"NDC"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUAIFENESIN ER 600 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-572-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.97,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE 0.1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-606-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-617-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":8.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 10 MEQ PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-632-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM CARBONATE ER 300 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-640-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.9,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIZANIDINE HCL 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-645-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL ER (SR) 100 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-697-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL ER 37.5 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-698-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.17,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL ER (SR) 150 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-708-95","type":"NDC"}],"standard_charges":[{"gross_charge":6.32,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-709-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.79,"discounted_cash":8.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-710-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":8.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-710-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":8.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL ER 150 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-713-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.41,"discounted_cash":9.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TEMAZEPAM 7.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-549-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.90,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-346-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-346-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOPIRAMATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-344-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.66,"discounted_cash":11.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACYCLOVIR 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-109-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 7.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.97,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-119-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.23,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-120-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-158-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.61,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-189-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINOXIDIL 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-204-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENZONATATE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-214-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-248-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.14,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-248-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYZINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-254-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-269-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.81,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISPERIDONE 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-270-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.15,"discounted_cash":8.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISPERIDONE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-271-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.90,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISPERIDONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-272-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.80,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETHAMBUTOL HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.6,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOPIRAMATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-344-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.8,"discounted_cash":11.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOPIRAMATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-342-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMOTRIGINE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-319-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.80,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 125 MG PO CSDR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-313-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-310-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":6.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 0.125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-305-56","type":"NDC"}],"standard_charges":[{"gross_charge":6.65,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-735-01","type":"NDC"}],"standard_charges":[{"gross_charge":111.63,"discounted_cash":66.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TAMSULOSIN HCL 0.4 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-299-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.95,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALTREXONE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-291-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":14.61,"discounted_cash":8.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-288-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":4.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUDROCORTISONE ACETATE 0.05 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-288-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYUREA 500 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-284-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA ER 50-200 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-282-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":5.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETHAMBUTOL HCL 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-280-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":3.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLESEVELAM HCL 625 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-433-18","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-735-11","type":"NDC"}],"standard_charges":[{"gross_charge":110.89,"discounted_cash":66.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-753-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.61,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOPIRAMATE 25 MG PO CAP-SPRINKLE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-005-14","type":"NDC"}],"standard_charges":[{"gross_charge":9.88,"discounted_cash":5.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-035-16","type":"NDC"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":8.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELOXICAM 7.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.45,"discounted_cash":6.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELOXICAM 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":9.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-096-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PAROXETINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-097-16","type":"NDC"}],"standard_charges":[{"gross_charge":11.05,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISPERIDONE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-114-14","type":"NDC"}],"standard_charges":[{"gross_charge":13.66,"discounted_cash":8.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-121-16","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHOLESTYRAMINE LIGHT 4 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-529-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":7.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-537-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.03,"discounted_cash":4.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUSPIRONE HCL 7.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-623-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-659-06","type":"NDC"}],"standard_charges":[{"gross_charge":7.04,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUDESONIDE 3 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-720-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.59,"discounted_cash":37.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 175 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-974-09","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-772-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.87,"discounted_cash":25.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROFLUMILAST 500 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-969-06","type":"NDC"}],"standard_charges":[{"gross_charge":41.4,"discounted_cash":24.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXCARBAZEPINE 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.15,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-180-22","type":"NDC"}],"standard_charges":[{"gross_charge":127.95,"discounted_cash":76.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAPROXEN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM CARBONATE 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-220-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM CARBONATE 300 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.21,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM CARBONATE ER 300 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LITHIUM CARBONATE ER 450 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.33,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-263-90","type":"NDC"}],"standard_charges":[{"gross_charge":25.42,"discounted_cash":15.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-264-05","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":15.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL ER 120 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-292-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-330-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.61,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDOMETHACIN 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-406-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 150 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-973-09","type":"NDC"}],"standard_charges":[{"gross_charge":5.96,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 125 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-971-09","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-969-09","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-753-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":4.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-776-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.95,"discounted_cash":5.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIVALPROEX SODIUM 500 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-782-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.55,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAMADOL HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-808-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.65,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLPHENIDATE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-823-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.92,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-854-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.4,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-854-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.90,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-855-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-859-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-001-59","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 0.4 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-001-62","type":"NDC"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":3.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-063-59","type":"NDC"}],"standard_charges":[{"gross_charge":14.77,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-231-59","type":"NDC"}],"standard_charges":[{"gross_charge":6.49,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-503-59","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-756-59","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-756-62","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-968-09","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVONORGESTREL 1.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-852-11","type":"NDC"}],"standard_charges":[{"gross_charge":93.9,"discounted_cash":56.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-719-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-677-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":39.25,"discounted_cash":23.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIFAMPIN 300 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-659-07","type":"NDC"}],"standard_charges":[{"gross_charge":15.69,"discounted_cash":9.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-752-19","type":"NDC"}],"standard_charges":[{"gross_charge":31.48,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMVASTATIN 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-479-03","type":"NDC"}],"standard_charges":[{"gross_charge":16.41,"discounted_cash":9.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETHAMBUTOL HCL 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":4.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-166-11","type":"NDC"}],"standard_charges":[{"gross_charge":80.06,"discounted_cash":48.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-137-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEKAS PLUS PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68176-00016","type":"NDC"}],"standard_charges":[{"gross_charge":6.03,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68094-764-59","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68180-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":409.12,"discounted_cash":245.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-733-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-630-01","type":"NDC"}],"standard_charges":[{"gross_charge":104.45,"discounted_cash":62.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"53489-120-02","type":"NDC"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BIOTIN 3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54022-1098-1","type":"NDC"}],"standard_charges":[{"gross_charge":2.57,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MESALAMINE ER 250 MG PO CAP-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54092-189-81","type":"NDC"}],"standard_charges":[{"gross_charge":10.78,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54643-5649-1","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54838-510-80","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIZANIDINE HCL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-179-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.29,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIZANIDINE HCL 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-180-15","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-292-36","type":"NDC"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIMEPIRIDE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-321-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.69,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIMEPIRIDE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.90,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METAXALONE 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-650-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.6,"discounted_cash":9.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55111-671-31","type":"NDC"}],"standard_charges":[{"gross_charge":71.07,"discounted_cash":42.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE CLOTH 2 % EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"53462-705-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.98,"discounted_cash":3.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-165-05","type":"NDC"}],"standard_charges":[{"gross_charge":8.15,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":28.6,"discounted_cash":17.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.68,"discounted_cash":17.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-221-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.83,"discounted_cash":28.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-222-20","type":"NDC"}],"standard_charges":[{"gross_charge":52.48,"discounted_cash":31.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-235-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.09,"discounted_cash":22.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-235-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.55,"discounted_cash":21.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-297-01","type":"NDC"}],"standard_charges":[{"gross_charge":260.96,"discounted_cash":156.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-297-10","type":"NDC"}],"standard_charges":[{"gross_charge":245.78,"discounted_cash":147.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-425-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.68,"discounted_cash":17.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-438-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.11,"discounted_cash":20.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETAMINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-438-10","type":"NDC"}],"standard_charges":[{"gross_charge":43.99,"discounted_cash":26.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MOI-STIR MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55299-60104","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":29.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IVABRADINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55513-800-60","type":"NDC"}],"standard_charges":[{"gross_charge":19.69,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":32.39,"discounted_cash":19.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 2 % EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"53329-244-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.86,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-0203-4","type":"NDC"}],"standard_charges":[{"gross_charge":55.03,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAFFEINE CITRATE 60 MG/3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-0501-3","type":"NDC"}],"standard_charges":[{"gross_charge":26.18,"discounted_cash":15.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYLEPHRINE HCL-NACL 50-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-4000-3","type":"NDC"}],"standard_charges":[{"gross_charge":90.35,"discounted_cash":54.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-5001-1","type":"NDC"}],"standard_charges":[{"gross_charge":35.72,"discounted_cash":21.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-5001-4","type":"NDC"}],"standard_charges":[{"gross_charge":46.16,"discounted_cash":27.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE-DEXTROSE 150-5 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-5001-5","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":3.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-5011-4","type":"NDC"}],"standard_charges":[{"gross_charge":38.26,"discounted_cash":22.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-5012-1","type":"NDC"}],"standard_charges":[{"gross_charge":46.1,"discounted_cash":27.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51862-454-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.95,"discounted_cash":84.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE 0.3 MG/24HR TD PTWK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51862-455-01","type":"NDC"}],"standard_charges":[{"gross_charge":193.7,"discounted_cash":116.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FA-PYRIDOXINE-CYANOCOBALAMIN 2.5-25-2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-384-90","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-747-90","type":"NDC"}],"standard_charges":[{"gross_charge":23.05,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-748-90","type":"NDC"}],"standard_charges":[{"gross_charge":21.9,"discounted_cash":13.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPLERENONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-877-33","type":"NDC"}],"standard_charges":[{"gross_charge":14.8,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 4.6 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-897-99","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETRACYCLINE HCL 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-906-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.55,"discounted_cash":12.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FIDAXOMICIN 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52015-080-01","type":"NDC"}],"standard_charges":[{"gross_charge":751.69,"discounted_cash":451.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THEOPHYLLINE ER 200 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52244-200-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":11.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PEG-3350/ELECTROLYTES 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52268-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":91.95,"discounted_cash":55.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 25 MG/ML PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52536-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.50,"discounted_cash":11.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52536-132-13","type":"NDC"}],"standard_charges":[{"gross_charge":54.6,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOPIRAMATE 25 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52652-9001-1","type":"NDC"}],"standard_charges":[{"gross_charge":22.51,"discounted_cash":13.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LUBRIDERM ADVANCED THERAPY EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52800-48231","type":"NDC"}],"standard_charges":[{"gross_charge":29.55,"discounted_cash":17.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52817-319-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.34,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOCARNITINE 1 GM/10ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52817-830-04","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.90,"discounted_cash":7.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"53329-171-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.75,"discounted_cash":19.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"53329-172-10","type":"NDC"}],"standard_charges":[{"gross_charge":29.48,"discounted_cash":17.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE 13.3 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-899-99","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DINOPROSTONE 10 MG VA INST","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55566-2800-0","type":"NDC"}],"standard_charges":[{"gross_charge":1050.7,"discounted_cash":630.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DINOPROSTONE 10 MG VA INST","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55566-2800-1","type":"NDC"}],"standard_charges":[{"gross_charge":1547.18,"discounted_cash":928.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALUM SULFATE-CA ACETATE EX PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57074-00177","type":"NDC"}],"standard_charges":[{"gross_charge":2.55,"discounted_cash":1.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59011-452-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.85,"discounted_cash":5.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARIPIPRAZOLE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59148-007-35","type":"NDC"}],"standard_charges":[{"gross_charge":91.75,"discounted_cash":55.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEPHRON FA PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59528-4456-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EZETIMIBE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-052-30","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EZETIMIBE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-052-90","type":"NDC"}],"standard_charges":[{"gross_charge":29.75,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOFETILIDE 250 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-119-60","type":"NDC"}],"standard_charges":[{"gross_charge":24.58,"discounted_cash":14.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOFETILIDE 500 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-120-60","type":"NDC"}],"standard_charges":[{"gross_charge":25.55,"discounted_cash":15.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TAMOXIFEN CITRATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-299-60","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOBAZAM 2.5 MG/ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-401-12","type":"NDC"}],"standard_charges":[{"gross_charge":188.42,"discounted_cash":113.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"URSODIOL 300 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59651-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.76,"discounted_cash":13.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TERAZOSIN HCL 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59746-383-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.13,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TERAZOSIN HCL 2 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59746-384-06","type":"NDC"}],"standard_charges":[{"gross_charge":8.32,"discounted_cash":4.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TERAZOSIN HCL 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59746-385-06","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":4.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-0055-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL ER 40 MG PO T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59011-440-20","type":"NDC"}],"standard_charges":[{"gross_charge":54.39,"discounted_cash":32.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFASALAZINE 500 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-0104-5","type":"NDC"}],"standard_charges":[{"gross_charge":3.76,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENELZINE SULFATE 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-0119-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-0333-2","type":"NDC"}],"standard_charges":[{"gross_charge":256.15,"discounted_cash":153.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-1061-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.76,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIFABUTIN 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-1350-1","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":28.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-2242-9","type":"NDC"}],"standard_charges":[{"gross_charge":8.90,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 200 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-3140-1","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-3304-3","type":"NDC"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFASALAZINE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-5000-5","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-1266-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TETRACYCLINE HCL 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-1522-1","type":"NDC"}],"standard_charges":[{"gross_charge":21.55,"discounted_cash":12.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62584-265-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-1748-2","type":"NDC"}],"standard_charges":[{"gross_charge":140.4,"discounted_cash":84.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAMADOL HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-2348-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.39,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM & SODIUM PHOSPHATES 280-160-250 MG PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60258-006-15","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.39,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MESALAMINE 400 MG PO CAP-DEL-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-0117-1","type":"NDC"}],"standard_charges":[{"gross_charge":11.93,"discounted_cash":7.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL ER 10 MG PO T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59011-410-20","type":"NDC"}],"standard_charges":[{"gross_charge":20.29,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL ER 10 MG PO T12A","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59011-410-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.69,"discounted_cash":11.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BALSAM PERU-CASTOR OIL EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58980-780-21","type":"NDC"}],"standard_charges":[{"gross_charge":115.1,"discounted_cash":69.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE 40 MG/ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-150-35","type":"NDC"}],"standard_charges":[{"gross_charge":79.23,"discounted_cash":47.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIOGLITAZONE HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-219-90","type":"NDC"}],"standard_charges":[{"gross_charge":19.42,"discounted_cash":11.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAMIPRIL 1.25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-222-30","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAMIPRIL 2.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.49,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAMIPRIL 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.69,"discounted_cash":5.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RAMIPRIL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-225-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.05,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SAMC CLINIMIX CPN WITH ADDITIVES","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57513-564-91","type":"NDC"}],"standard_charges":[{"gross_charge":2833.8,"discounted_cash":1700.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIGOXIN 125 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57664-437-88","type":"NDC"}],"standard_charges":[{"gross_charge":7.74,"discounted_cash":4.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.15,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIZANIDINE HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57664-502-89","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.65,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57664-808-88","type":"NDC"}],"standard_charges":[{"gross_charge":4.29,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MINOCYCLINE HCL 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57664-853-85","type":"NDC"}],"standard_charges":[{"gross_charge":11.17,"discounted_cash":6.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NALOXEGOL OXALATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57841-1301-3","type":"NDC"}],"standard_charges":[{"gross_charge":43.3,"discounted_cash":25.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BENGAY GREASELESS 10-15 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-116-03","type":"NDC"}],"standard_charges":[{"gross_charge":31.6,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYSPORIN 500-10000 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58980-012-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.9,"discounted_cash":18.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58526-00557","type":"NDC"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":9.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58160-976-02","type":"NDC"}],"standard_charges":[{"gross_charge":694.16,"discounted_cash":416.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58160-816-03","type":"NDC"}],"standard_charges":[{"gross_charge":64.96,"discounted_cash":38.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58151-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.93,"discounted_cash":3.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VERAPAMIL HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-0203-1","type":"NDC"}],"standard_charges":[{"gross_charge":56.7,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 81 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-981-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 325 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-921-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-629-12","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-555-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES 8.6 MG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-434-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-184-05","type":"NDC"}],"standard_charges":[{"gross_charge":26.4,"discounted_cash":15.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN-HYPROMELLOSE-PEG 400 0.2-0.2-1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-181-05","type":"NDC"}],"standard_charges":[{"gross_charge":27.05,"discounted_cash":16.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASPIRIN 325 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-921-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.7,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-0108-3","type":"NDC"}],"standard_charges":[{"gross_charge":99.53,"discounted_cash":59.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID-NACL 1000-0.7 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-0108-1","type":"NDC"}],"standard_charges":[{"gross_charge":111.62,"discounted_cash":66.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE ER 100 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4123-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-755-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.60,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-755-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.34,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-758-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.45,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-787-11","type":"NDC"}],"standard_charges":[{"gross_charge":369.08,"discounted_cash":221.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALACYCLOVIR HCL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-788-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE HCL 20 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-811-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIPRASIDONE HCL 60 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-813-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.83,"discounted_cash":6.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYANOCOBALAMIN 250 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-853-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.08,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYANOCOBALAMIN 1000 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-855-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.84,"discounted_cash":2.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN D3 125 MCG (5000 UT) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-866-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.31,"discounted_cash":3.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-745-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":15.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WITCH HAZEL-GLYCERIN EX PADS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50289-3250-1","type":"NDC"}],"standard_charges":[{"gross_charge":28.99,"discounted_cash":17.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVAROXABAN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50458-577-60","type":"NDC"}],"standard_charges":[{"gross_charge":32.45,"discounted_cash":19.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVAROXABAN 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50458-578-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.14,"discounted_cash":33.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVAROXABAN 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50458-578-90","type":"NDC"}],"standard_charges":[{"gross_charge":61.23,"discounted_cash":36.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVAROXABAN 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50458-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.52,"discounted_cash":33.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVAROXABAN 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50458-580-10","type":"NDC"}],"standard_charges":[{"gross_charge":57.25,"discounted_cash":34.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRIVARACETAM 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50474-570-09","type":"NDC"}],"standard_charges":[{"gross_charge":73.66,"discounted_cash":44.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRIVARACETAM 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50474-570-66","type":"NDC"}],"standard_charges":[{"gross_charge":73.09,"discounted_cash":43.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRIVARACETAM 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50474-870-15","type":"NDC"}],"standard_charges":[{"gross_charge":166.10,"discounted_cash":99.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLLAGENASE 250 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50484-010-30","type":"NDC"}],"standard_charges":[{"gross_charge":922.89,"discounted_cash":553.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50580-458-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.30,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CETIRIZINE-PSEUDOEPHEDRINE ER 5-120 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50580-728-12","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE ER 15 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.85,"discounted_cash":7.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-176-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.16,"discounted_cash":7.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVAROXABAN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50458-577-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.03,"discounted_cash":19.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-743-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":3.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-742-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.40,"discounted_cash":3.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-741-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.10,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-504-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-505-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.82,"discounted_cash":2.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-506-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELATONIN 3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-524-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELATONIN 1.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-524-15","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELOXICAM 3.75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-525-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.45,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.65,"discounted_cash":6.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELOXICAM 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-526-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":9.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-535-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":3.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL SUCCINATE ER 12.5 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-540-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.34,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHENAMINE HIPPURATE 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-549-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-556-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-562-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MONTELUKAST SODIUM 4 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-573-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEMANTINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-588-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAPROXEN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-594-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.11,"discounted_cash":3.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TAMSULOSIN HCL 0.4 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-740-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-728-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.25,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SEVELAMER CARBONATE 800 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-720-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.24,"discounted_cash":14.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RALOXIFENE HCL 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-694-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.05,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-666-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-646-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":7.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-262-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":6.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-644-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.51,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PAROXETINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-640-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.17,"discounted_cash":3.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-639-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.5,"discounted_cash":8.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-630-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":13.23,"discounted_cash":7.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORTRIPTYLINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-604-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORTRIPTYLINE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-603-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.05,"discounted_cash":3.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IVABRADINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-362-60","type":"NDC"}],"standard_charges":[{"gross_charge":29.15,"discounted_cash":17.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NITROGLYCERIN 0.3 MG/HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-515-01","type":"NDC"}],"standard_charges":[{"gross_charge":159.9,"discounted_cash":95.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-801-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-810-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.16,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-821-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.82,"discounted_cash":7.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-966-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.9,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA ER 25-100 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-978-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":2.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUSPIRONE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-985-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.51,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.22,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51224-022-30","type":"NDC"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOLIFENACIN SUCCINATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51248-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.3,"discounted_cash":25.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LETS KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51552-1345-1","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":9.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-1258-1","type":"NDC"}],"standard_charges":[{"gross_charge":336.6,"discounted_cash":201.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-1260-3","type":"NDC"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-1275-6","type":"NDC"}],"standard_charges":[{"gross_charge":143.1,"discounted_cash":85.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-1312-0","type":"NDC"}],"standard_charges":[{"gross_charge":84.6,"discounted_cash":50.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPRAZOLAM 0.125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-788-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.03,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-2075-2","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 80 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-2114-2","type":"NDC"}],"standard_charges":[{"gross_charge":6.51,"discounted_cash":3.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-2116-0","type":"NDC"}],"standard_charges":[{"gross_charge":6.59,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-2116-2","type":"NDC"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":4.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORTRIPTYLINE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4001-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORTRIPTYLINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4002-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.25,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NORTRIPTYLINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4002-5","type":"NDC"}],"standard_charges":[{"gross_charge":2.90,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOMIPRAMINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4011-6","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENALAPRIL MALEATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4038-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.75,"discounted_cash":5.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4047-9","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYTOIN 125 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4069-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.27,"discounted_cash":4.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CETIRIZINE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4070-8","type":"NDC"}],"standard_charges":[{"gross_charge":11.55,"discounted_cash":6.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4111-1","type":"NDC"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":2.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4116-6","type":"NDC"}],"standard_charges":[{"gross_charge":803.15,"discounted_cash":481.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROURACIL 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4118-6","type":"NDC"}],"standard_charges":[{"gross_charge":963.3,"discounted_cash":577.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 80 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-2114-0","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-782-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.45,"discounted_cash":9.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATENOLOL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-759-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.47,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 12.5-50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-756-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIFEDIPINE ER 30 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.47,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIFEDIPINE ER 60 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-621-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.7,"discounted_cash":6.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-042-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.79,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-072-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-073-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISONIAZID 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-083-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-141-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALLOPURINOL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.44,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALLOPURINOL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-205-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALLOPURINOL 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.5,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.50,"discounted_cash":3.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATORVASTATIN 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-208-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-255-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-736-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":3.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-734-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.30,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-734-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HALOPERIDOL 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-733-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATENOLOL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-684-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MELOXICAM 3.75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-457-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-505-04","type":"NDC"}],"standard_charges":[{"gross_charge":53.95,"discounted_cash":32.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 12.5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-444-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMTERENE-HCTZ 18.75-12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-433-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-375-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE HCL 0.05 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-299-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-285-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.93,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-285-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.20,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.78,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXEPIN HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-436-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM THIOSULFATE 250 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60267-705-50","type":"NDC"}],"standard_charges":[{"gross_charge":2.48,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60219-1617-8","type":"NDC"}],"standard_charges":[{"gross_charge":28.22,"discounted_cash":16.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXAZOSIN MESYLATE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0093-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHIMAZOLE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-669-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.58,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHIMAZOLE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-669-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-675-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYZINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.03,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL FUMARATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-679-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.29,"discounted_cash":4.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHIMAZOLE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-680-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOLIC ACID 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-681-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LACOSAMIDE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-687-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.59,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALLOPURINOL 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-688-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.95,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUCRALFATE 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-695-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.80,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXCARBAZEPINE 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-711-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXCARBAZEPINE 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-711-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.53,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROXYZINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-664-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.50,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-717-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.95,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.17,"discounted_cash":3.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-717-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-723-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.44,"discounted_cash":14.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-725-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.62,"discounted_cash":8.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 60 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-728-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.80,"discounted_cash":3.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-734-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.45,"discounted_cash":14.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-734-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.04,"discounted_cash":13.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-736-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.30,"discounted_cash":3.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-740-24","type":"NDC"}],"standard_charges":[{"gross_charge":9.91,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AZITHROMYCIN 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-742-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.23,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-745-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.26,"discounted_cash":13.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MISOPROSTOL 200 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-746-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.78,"discounted_cash":4.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-760-40","type":"NDC"}],"standard_charges":[{"gross_charge":8.24,"discounted_cash":4.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-762-17","type":"NDC"}],"standard_charges":[{"gross_charge":5.09,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-762-40","type":"NDC"}],"standard_charges":[{"gross_charge":4.35,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VALGANCICLOVIR HCL 50 MG/ML PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-765-13","type":"NDC"}],"standard_charges":[{"gross_charge":88.25,"discounted_cash":52.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-661-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.65,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-657-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOCARBAMOL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-559-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOCARBAMOL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-559-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.77,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SELEGILINE HCL 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0055-1","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOCARBAMOL 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-568-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-570-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-576-40","type":"NDC"}],"standard_charges":[{"gross_charge":18.95,"discounted_cash":11.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-580-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":3.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-581-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.37,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANTOPRAZOLE SODIUM 20 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-585-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.57,"discounted_cash":8.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-587-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.77,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.06,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-587-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.74,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 300 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-591-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.84,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-593-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-593-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-598-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 400 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-602-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.76,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GABAPENTIN 400 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-602-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":3.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-603-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-614-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":3.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-617-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.92,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-622-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.31,"discounted_cash":2.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-627-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.46,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-627-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.36,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-631-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 10 MEQ PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-632-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-638-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.07,"discounted_cash":2.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-656-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.3,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FAMOTIDINE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-595-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-775-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.06,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-794-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":2.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAMADOL HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-795-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-032-31","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-063-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.99,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARIPIPRAZOLE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-097-30","type":"NDC"}],"standard_charges":[{"gross_charge":82.75,"discounted_cash":49.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARIPIPRAZOLE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-097-31","type":"NDC"}],"standard_charges":[{"gross_charge":82.63,"discounted_cash":49.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARIPIPRAZOLE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-099-30","type":"NDC"}],"standard_charges":[{"gross_charge":81.36,"discounted_cash":48.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ARIPIPRAZOLE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-099-31","type":"NDC"}],"standard_charges":[{"gross_charge":81.10,"discounted_cash":48.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CELECOXIB 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-141-31","type":"NDC"}],"standard_charges":[{"gross_charge":15.15,"discounted_cash":9.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CELECOXIB 200 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-142-31","type":"NDC"}],"standard_charges":[{"gross_charge":21.84,"discounted_cash":13.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FEBUXOSTAT 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-190-30","type":"NDC"}],"standard_charges":[{"gross_charge":33.82,"discounted_cash":20.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOMIPRAMINE HCL 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-407-31","type":"NDC"}],"standard_charges":[{"gross_charge":28.40,"discounted_cash":17.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LURASIDONE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-494-30","type":"NDC"}],"standard_charges":[{"gross_charge":94.83,"discounted_cash":56.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LURASIDONE HCL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-495-30","type":"NDC"}],"standard_charges":[{"gross_charge":94.83,"discounted_cash":56.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL FUMARATE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-603-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.4,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.89,"discounted_cash":5.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-031-31","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL FUMARATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-603-31","type":"NDC"}],"standard_charges":[{"gross_charge":7.82,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OPIUM 10 MG/ML (1%) PO TINC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-153-04","type":"NDC"}],"standard_charges":[{"gross_charge":29.82,"discounted_cash":17.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUVOXAMINE MALEATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.38,"discounted_cash":5.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPAFENONE HCL 150 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-230-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPAFENONE HCL 225 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.35,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACEBUTOLOL HCL 200 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-291-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.32,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLECAINIDE ACETATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-380-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLECAINIDE ACETATE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-380-56","type":"NDC"}],"standard_charges":[{"gross_charge":8.29,"discounted_cash":4.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLECAINIDE ACETATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-381-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.00,"discounted_cash":6.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLESTIPOL HCL 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-395-12","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-431-30","type":"NDC"}],"standard_charges":[{"gross_charge":226.6,"discounted_cash":135.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-490-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDAPAMIDE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-511-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.45,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"UREA 15 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62530-00010","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":8.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-030-31","type":"NDC"}],"standard_charges":[{"gross_charge":9.45,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TALC 4 G PL POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62327-444-04","type":"NDC"}],"standard_charges":[{"gross_charge":502.6,"discounted_cash":301.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62037-598-90","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":4.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAMADOL HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-795-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.62,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-800-40","type":"NDC"}],"standard_charges":[{"gross_charge":10.97,"discounted_cash":6.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-822-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-822-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":2.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-833-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":2.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-845-77","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMATINIB MESYLATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-882-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.31,"discounted_cash":7.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60758-802-05","type":"NDC"}],"standard_charges":[{"gross_charge":29.6,"discounted_cash":17.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIOTHYRONINE SODIUM 12.5 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60793-116-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.61,"discounted_cash":3.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THROMBIN 5000 UNITS EX SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60793-215-05","type":"NDC"}],"standard_charges":[{"gross_charge":217.74,"discounted_cash":130.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-014-05","type":"NDC"}],"standard_charges":[{"gross_charge":201.85,"discounted_cash":121.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIFLURIDINE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-044-75","type":"NDC"}],"standard_charges":[{"gross_charge":621.65,"discounted_cash":372.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-126-10","type":"NDC"}],"standard_charges":[{"gross_charge":536.2,"discounted_cash":321.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-226-05","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-227-05","type":"NDC"}],"standard_charges":[{"gross_charge":65.1,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-227-15","type":"NDC"}],"standard_charges":[{"gross_charge":142.6,"discounted_cash":85.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61958-2501-1","type":"NDC"}],"standard_charges":[{"gross_charge":401.66,"discounted_cash":241.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ELVITEG-COBIC-EMTRICIT-TENOFAF 150-150-200-10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61958-1901-1","type":"NDC"}],"standard_charges":[{"gross_charge":405.31,"discounted_cash":243.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61570-131-98","type":"NDC"}],"standard_charges":[{"gross_charge":391.60,"discounted_cash":234.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61570-131-25","type":"NDC"}],"standard_charges":[{"gross_charge":39.12,"discounted_cash":23.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-645-11","type":"NDC"}],"standard_charges":[{"gross_charge":279.6,"discounted_cash":167.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-637-05","type":"NDC"}],"standard_charges":[{"gross_charge":158.65,"discounted_cash":95.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-558-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-633-05","type":"NDC"}],"standard_charges":[{"gross_charge":76.55,"discounted_cash":45.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-628-10","type":"NDC"}],"standard_charges":[{"gross_charge":66.1,"discounted_cash":39.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-547-01","type":"NDC"}],"standard_charges":[{"gross_charge":255.5,"discounted_cash":153.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-396-03","type":"NDC"}],"standard_charges":[{"gross_charge":122.45,"discounted_cash":73.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.52,"discounted_cash":38.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-355-02","type":"NDC"}],"standard_charges":[{"gross_charge":139.75,"discounted_cash":83.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARTEOLOL HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-238-05","type":"NDC"}],"standard_charges":[{"gross_charge":75.55,"discounted_cash":45.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-631-36","type":"NDC"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":78.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISONIAZID 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-553-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-550-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.9,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE HCL 0.1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-113-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.82,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE HCL 0.1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-113-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":2.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METFORMIN HCL 850 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-143-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEPHALEXIN 250 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-152-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.22,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METFORMIN HCL 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-155-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.35,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENYTOIN 50 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-156-95","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEPHALEXIN 500 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-163-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.62,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-169-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.39,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DONEPEZIL HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEMANTINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-173-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-190-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.63,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IMATINIB MESYLATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-192-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-195-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.73,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-206-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.37,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GEMFIBROZIL 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-224-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOPERAMIDE HCL 2 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-229-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZONISAMIDE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-230-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SERTRALINE HCL 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":3.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SERTRALINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-231-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SERTRALINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-242-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.11,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SERTRALINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-242-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.51,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-244-40","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":13.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-245-11","type":"NDC"}],"standard_charges":[{"gross_charge":21.96,"discounted_cash":13.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-550-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.77,"discounted_cash":4.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-267-42","type":"NDC"}],"standard_charges":[{"gross_charge":12.1,"discounted_cash":7.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DONEPEZIL HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-292-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DONEPEZIL HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-292-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SIMVASTATIN 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-210-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ANASTROZOLE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-112-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 75 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-7083-2","type":"NDC"}],"standard_charges":[{"gross_charge":149.4,"discounted_cash":89.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 50 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-7082-2","type":"NDC"}],"standard_charges":[{"gross_charge":99.55,"discounted_cash":59.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXAZOSIN MESYLATE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0094-0","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":3.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0141-0","type":"NDC"}],"standard_charges":[{"gross_charge":4.90,"discounted_cash":2.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLIPIZIDE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0142-0","type":"NDC"}],"standard_charges":[{"gross_charge":5.43,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0157-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAVASTATIN SODIUM 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0170-9","type":"NDC"}],"standard_charges":[{"gross_charge":14.8,"discounted_cash":8.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0183-0","type":"NDC"}],"standard_charges":[{"gross_charge":7.99,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TIZANIDINE HCL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0251-3","type":"NDC"}],"standard_charges":[{"gross_charge":6.29,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0560-0","type":"NDC"}],"standard_charges":[{"gross_charge":74.7,"discounted_cash":44.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0582-4","type":"NDC"}],"standard_charges":[{"gross_charge":50.85,"discounted_cash":30.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0815-0","type":"NDC"}],"standard_charges":[{"gross_charge":624.7,"discounted_cash":374.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0823-6","type":"NDC"}],"standard_charges":[{"gross_charge":312.95,"discounted_cash":187.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0827-1","type":"NDC"}],"standard_charges":[{"gross_charge":257.25,"discounted_cash":154.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0829-1","type":"NDC"}],"standard_charges":[{"gross_charge":230.90,"discounted_cash":138.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-1320-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-1321-1","type":"NDC"}],"standard_charges":[{"gross_charge":8.51,"discounted_cash":5.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BALSALAZIDE DISODIUM 750 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-2575-7","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":3.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAMTERENE-HCTZ 37.5-25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-2656-1","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL 12 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-7080-2","type":"NDC"}],"standard_charges":[{"gross_charge":54.2,"discounted_cash":32.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 21 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-7063-0","type":"NDC"}],"standard_charges":[{"gross_charge":10.95,"discounted_cash":6.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 14 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-7062-0","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 7 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-7061-0","type":"NDC"}],"standard_charges":[{"gross_charge":9.35,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICOTINE 7 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-706-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.9,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-6226-0","type":"NDC"}],"standard_charges":[{"gross_charge":134.6,"discounted_cash":80.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ITRACONAZOLE 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-299-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.04,"discounted_cash":7.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRASUGREL HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-4643-3","type":"NDC"}],"standard_charges":[{"gross_charge":42.68,"discounted_cash":25.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRASUGREL HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-4642-3","type":"NDC"}],"standard_charges":[{"gross_charge":44.95,"discounted_cash":26.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OLANZAPINE 5 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-3275-0","type":"NDC"}],"standard_charges":[{"gross_charge":37.62,"discounted_cash":22.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OLANZAPINE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-3111-0","type":"NDC"}],"standard_charges":[{"gross_charge":35.49,"discounted_cash":21.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OLANZAPINE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-3110-0","type":"NDC"}],"standard_charges":[{"gross_charge":30.80,"discounted_cash":18.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":32.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-4754-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":7.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DONEPEZIL HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-303-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.41,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-249-40","type":"NDC"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":11.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAPTOPRIL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-315-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.15,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMITRIPTYLINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-433-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.34,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIODARONE HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-437-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.66,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LINEZOLID 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-309-11","type":"NDC"}],"standard_charges":[{"gross_charge":313.05,"discounted_cash":187.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-439-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.80,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAZODONE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-443-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAZODONE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-443-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-446-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.00,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 25 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-453-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRAZODONE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-454-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.81,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 600 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-457-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-464-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.99,"discounted_cash":3.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SPIRONOLACTONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.05,"discounted_cash":3.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-465-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.05,"discounted_cash":2.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-431-99","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-473-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.42,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SPIRONOLACTONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-476-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":1.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-479-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NAPROXEN 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-491-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-495-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.6,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 75 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-495-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.94,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-496-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.95,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-497-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.69,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.18,"discounted_cash":4.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 100 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-506-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.11,"discounted_cash":4.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-526-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 150 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-530-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONAZEPAM 0.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-544-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":4.87,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOZAPINE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-548-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":4.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 75 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-475-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.30,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 G PO PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-431-98","type":"NDC"}],"standard_charges":[{"gross_charge":11.45,"discounted_cash":6.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-418-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.70,"discounted_cash":4.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-327-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.50,"discounted_cash":8.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":13.32,"discounted_cash":7.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-333-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.77,"discounted_cash":2.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-333-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-338-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.67,"discounted_cash":11.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CALCITRIOL 0.25 MCG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-345-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.85,"discounted_cash":3.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-349-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.45,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPROPION HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-351-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHIMAZOLE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-357-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICYCLOMINE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-369-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.99,"discounted_cash":3.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FINASTERIDE 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-428-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLCHICINE 0.6 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-389-11","type":"NDC"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"COLCHICINE 0.3 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-389-21","type":"NDC"}],"standard_charges":[{"gross_charge":31.85,"discounted_cash":19.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL SUCCINATE ER 12.5 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-390-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.4,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DRONABINOL 2.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-375-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.53,"discounted_cash":14.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-394-79","type":"NDC"}],"standard_charges":[{"gross_charge":5.55,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-418-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.80,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-417-44","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-390-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL SUCCINATE ER 100 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-413-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.37,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-406-77","type":"NDC"}],"standard_charges":[{"gross_charge":20.43,"discounted_cash":12.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-406-40","type":"NDC"}],"standard_charges":[{"gross_charge":20.60,"discounted_cash":12.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-405-79","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOZAPINE 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-415-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.03,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOZAPINE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-404-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.24,"discounted_cash":4.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TAB-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.27,"discounted_cash":4.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDODRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-398-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.92,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-396-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":3.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-395-79","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HC ROOM & CARE PRIVATE","code_information":[{"code":"1100001","type":"CDM"},{"code":"0110","type":"RC"},{"code":"1100001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3068.0,"discounted_cash":1840.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE SEMI-PRIVATE","code_information":[{"code":"1200001","type":"CDM"},{"code":"0120","type":"RC"},{"code":"1200001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3068.0,"discounted_cash":1840.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE SEMI-PRIVATE INTERMEDIATE","code_information":[{"code":"1200003","type":"CDM"},{"code":"0120","type":"RC"},{"code":"1200003","type":"HCPCS"}],"standard_charges":[{"gross_charge":4972.0,"discounted_cash":2983.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE SEMI-PRIVATE TELEMETRY","code_information":[{"code":"1210001","type":"CDM"},{"code":"0121","type":"RC"},{"code":"1210001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3068.0,"discounted_cash":1840.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE SEMI-PRIVATE OB","code_information":[{"code":"1220001","type":"CDM"},{"code":"0122","type":"RC"},{"code":"1220001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3068.0,"discounted_cash":1840.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE HOSPITAL AT HOME","code_information":[{"code":"1610001","type":"CDM"},{"code":"0161","type":"RC"},{"code":"1610001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3068.0,"discounted_cash":1840.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE NEWBORN LEVEL I","code_information":[{"code":"1710001","type":"CDM"},{"code":"0171","type":"RC"},{"code":"1710001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.0,"discounted_cash":902.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE NEWBORN LEVEL II","code_information":[{"code":"1720001","type":"CDM"},{"code":"0172","type":"RC"},{"code":"1720001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3438.0,"discounted_cash":2062.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE INTENSIVE CARE","code_information":[{"code":"2000001","type":"CDM"},{"code":"0200","type":"RC"},{"code":"2000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":9620.0,"discounted_cash":5772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE TRAUMA INTENSIVE CARE","code_information":[{"code":"2000002","type":"CDM"},{"code":"0208","type":"RC"},{"code":"2000002","type":"HCPCS"}],"standard_charges":[{"gross_charge":11703.0,"discounted_cash":7021.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROOM & CARE INTERMEDIATE / POST INTENSIVE CARE","code_information":[{"code":"2060001","type":"CDM"},{"code":"0206","type":"RC"},{"code":"2060001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5258.0,"discounted_cash":3154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STRATTICE TM, USED PER SQ CM","code_information":[{"code":"2688869","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4130","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STRATTICE TM, DISCARDED PER SQ CM","code_information":[{"code":"2688870","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4130","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC ALLODERM, HIGH COST, USED PER SQ CM","code_information":[{"code":"2688871","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4116","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ALLODERM, HIGH COST, DISCARDED PER SQ CM","code_information":[{"code":"2688872","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4116","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC GRAFTJACKET, HIGH COST, USED PER SQ CM","code_information":[{"code":"2688873","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4107","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":469.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GRAFTJACKET, HIGH COST, DISCARDED PER SQ CM","code_information":[{"code":"2688874","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4107","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.0,"discounted_cash":469.8,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4102 OASIS WOUND MATRIX USED PER SQ CM, LOW COST","code_information":[{"code":"2688877","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OASIS WOUND MATRIX DISCARDED PER SQ CM, LOW COST","code_information":[{"code":"2688878","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4102","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4101 APLIGRAF, HIGH COST, PER SQ CM USED","code_information":[{"code":"2688879","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4101 APLIGRAF, HIGH COST, PER SQ CM WASTED","code_information":[{"code":"2688880","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4110 PRIMATRIX, HIGH COST, PER SQ CM WASTED","code_information":[{"code":"2688881","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4110","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4110 PRIMATRIX, HIGH COST, PER SQ CM USED","code_information":[{"code":"2688882","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4110","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CORNEAL TISSUE FOR IMPLANT","code_information":[{"code":"2688893","type":"CDM"},{"code":"0278","type":"RC"},{"code":"V2785","type":"HCPCS"}],"standard_charges":[{"gross_charge":16484.0,"discounted_cash":9890.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4133 GRAFIX PRIME PER SQ CM USED","code_information":[{"code":"2688894","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":580.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4133 GRAFIX PRIME PER SQ CM WASTED","code_information":[{"code":"2688895","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":967.0,"discounted_cash":580.2,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC GRAFIX CORE PER SQ CM USED","code_information":[{"code":"2688898","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["JC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JC: Skin substitute used as a graft"}]},{"description":"HC GRAFIX CORE PER SQ CM WASTED","code_information":[{"code":"2688899","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4132","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4160 NUSHIELD, PER SQ CM USED","code_information":[{"code":"2688900","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4160 NUSHIELD, PER SQ CM WASTED","code_information":[{"code":"2688901","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.0,"discounted_cash":1200.0,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4159 AFFINITY, PER SQ CM USED","code_information":[{"code":"2688904","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1327.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4159 AFFINITY, PER SQ CM WASTED","code_information":[{"code":"2688905","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"gross_charge":2212.0,"discounted_cash":1327.2,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4186 EPIFIX PER SQ CM USED","code_information":[{"code":"2688908","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.0,"discounted_cash":775.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4186 EPIFIX PER SQ CM WASTED","code_information":[{"code":"2688909","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":1293.0,"discounted_cash":775.8,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4195 PURAPLY PER SQ CM WASTED","code_information":[{"code":"2688910","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4195","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":307.2,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4196 PURAPLY AM PER SQ CM WASTED","code_information":[{"code":"2688911","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":307.2,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4197 PURAPLY XT PER SQ CM WASTED","code_information":[{"code":"2688912","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4197","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":307.2,"setting":"both","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier JW: Drug amount discarded/not administered to any patient"}]},{"description":"HC Q4195 PURAPLY PER SQ CM USED","code_information":[{"code":"2688913","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4195","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":307.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4196 PURAPLY AM PER SQ CM USED","code_information":[{"code":"2688914","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":307.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q4197 PURAPLY XT PER SQ CM USED","code_information":[{"code":"2688915","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q4197","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":307.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 3LUM W/ ANTISEP 7FRX20CM","code_information":[{"code":"2700050","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN MULTI LUM W/ BL 7.0FRX8.0IN","code_information":[{"code":"2700054","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 1LUM ARROW KT 16GAX20CM","code_information":[{"code":"2700056","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN ART LN INSRT KT 20GAX12CM","code_information":[{"code":"2700057","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 2 LUM W/ INTEGR 9.0FRX10CM","code_information":[{"code":"2700058","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROC CATH CTR VEN LN 3LUM BL 7FRX20CM","code_information":[{"code":"2700059","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN MULTI LUM W/ BL 5.5FRX13CM","code_information":[{"code":"2700060","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN KT 3LUM LG BORE 12FRX16CM","code_information":[{"code":"2700062","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4576.0,"discounted_cash":2745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 2 LUM W/ FLEXTIP BL 7FRX21CM","code_information":[{"code":"2700063","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 2LUM KT 8.0FRX16CM","code_information":[{"code":"2700065","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR THERMDILUT S TP MULTIFLX 7FRX110CM","code_information":[{"code":"2700108","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR THERMDILUT MULTIFLX 7FRX110CM","code_information":[{"code":"2700110","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR THERMDILUT 5 LUM MULTIFLX 8FRX110CM","code_information":[{"code":"2700113","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE FOOT STIRUP PLSTC SHLL AIR GEL FM","code_information":[{"code":"2700356","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE STIRUP AIR FM VELCR STRAP 10.5IN","code_information":[{"code":"2700358","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WALK ANKLE STIRUP SPLNT SPORT RT","code_information":[{"code":"2700359","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE PONY LACE LK LT","code_information":[{"code":"2700360","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE FOOT STIRUP NAR PLSTC SHLL 9IN","code_information":[{"code":"2700362","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE LACE LK LT UNIV ADLT","code_information":[{"code":"2700363","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE LACE LK RT UNIV ADLT","code_information":[{"code":"2700364","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE MULTI LUM W/ ANISEPTIC 7FRX20CM","code_information":[{"code":"2700633","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE 1LUM RADIOPQ 7FRX20CM","code_information":[{"code":"2700635","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE RX KT 8.5FRX2.5IN","code_information":[{"code":"2700637","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATH GROSHONG NXT PICC 1LUM CLEARVUE 4FR","code_information":[{"code":"2700639","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH JUG ACCESS PUNC KT 16GAX16CM","code_information":[{"code":"2700641","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR INJ 3LUM W/ PTFE 6FRX135CM","code_information":[{"code":"2700643","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR INJ 1LUM W/ NITINOL 5FRX135CM","code_information":[{"code":"2700644","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR INJ SOLO W/ STD 4FRX135CM","code_information":[{"code":"2700645","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR SOLO RAD TRAY 5FRX135CM","code_information":[{"code":"2700646","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR SOLO 3LUM 6FRX135CM","code_information":[{"code":"2700647","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PWR PICC 1LUM GROSHONG 5FRX55CM","code_information":[{"code":"2700649","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL POWERLOC INFUSE SFTY W/O Y SITE 20GAX1IN","code_information":[{"code":"2701194","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL POWERLOC INFUSE SFTY W/O Y 19GAX1.0IN","code_information":[{"code":"2701195","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL POWERLOC INFUSE SFTY W/O Y SITE 22GAX1IN","code_information":[{"code":"2701196","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH VESSL UMB 1LUM INSRT TRAY NEO SERT 5FR","code_information":[{"code":"2701444","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIOP SITE IDENTIFIER F/USE IN 12G BX/10","code_information":[{"code":"2701822","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2701822","type":"HCPCS"}],"standard_charges":[{"gross_charge":5395.0,"discounted_cash":3237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIOP SITE IDENTIFIER F/ USE IN 12G US & STX","code_information":[{"code":"2701823","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2701823","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER PAD W/ VELCR M MED","code_information":[{"code":"2701847","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER PAD W/ VELCR F SM","code_information":[{"code":"2701849","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER PAD W/ VELCR F MED","code_information":[{"code":"2701850","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER CANVS M MED","code_information":[{"code":"2701851","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO F LG","code_information":[{"code":"2701852","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO M LG","code_information":[{"code":"2701853","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO M SM","code_information":[{"code":"2701854","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO F SM","code_information":[{"code":"2701855","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO M MED","code_information":[{"code":"2701856","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO F MED","code_information":[{"code":"2701857","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER CANVS M SM","code_information":[{"code":"2701858","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER CANVS F SM","code_information":[{"code":"2701859","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER CANVS F MED","code_information":[{"code":"2701860","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV EXTRIC STIFNECK NO NECK BABY","code_information":[{"code":"2702445","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV EXTRIC STIFNECK NO NECK PEDI","code_information":[{"code":"2702446","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV EXTRIC STIFNECK ADLT SHRT","code_information":[{"code":"2702447","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV EXTRIC GRN ADLT TALL","code_information":[{"code":"2702448","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV EXTRIC STIFNECK ADLT REG","code_information":[{"code":"2702449","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV EXTRIC STIFNECK NO NECK ADLT","code_information":[{"code":"2702450","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER CENTRAL VENOUS LINE PRESSURE INJECTA","code_information":[{"code":"2702744","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS MULTI LUMEN EXTREME ARROWGUARD SAFET","code_information":[{"code":"2702745","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS DUAL LUMEN 6FR X 20CM","code_information":[{"code":"2702747","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CARDIOVASCULAR GROSHONG SINGLE LUMEN SLIM 8FR","code_information":[{"code":"2702748","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MOTARJEME CATHETERS SOFTOUCH MOTARJEME 4FR .041/1.04MM","code_information":[{"code":"2702752","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER ANGIOGRAPHY PERFORMA MODIFIED SIMMONS .042IN X 1.5","code_information":[{"code":"2702753","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEEDLE POWERLOC INFUSION SAFETY WITHOUT Y SITE 20GA X .75IN","code_information":[{"code":"2702886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEEDLE INFUSION SAFETY POWERLOC WITH Y SITE SET 20GA X 1.0IN","code_information":[{"code":"2702887","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLAR CERVICAL NECK MIAMI J WITH PAD XSMALL","code_information":[{"code":"2702902","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0174","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETHER PIGTAIL TEMPO FLUSH 4FR X 100CM","code_information":[{"code":"2703284","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV HICKMN 2LUM SURECUFF W/ PERQ 9FR","code_information":[{"code":"2703701","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 2LUM SURECUFF TISS INGRWTH 9.5FR","code_information":[{"code":"2703702","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN ACCESS 2LUM 9FRX.035INX11.5CM","code_information":[{"code":"2703703","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SET CATH EXCHNG RAPD INFUSE 7FRX2.0IN","code_information":[{"code":"2704165","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR INJ 1LUM W/ NURS FULL TRAY 5FR","code_information":[{"code":"2704166","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CARDIOVASCULAR GROSHONG SNGLE LUMEN XLONG 8FR","code_information":[{"code":"2704780","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS CENTRAL SINGLE LUMEN LATEX FREE PEDIATRIC","code_information":[{"code":"2706069","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT CATHETERIZATION PRESSURE INJECTABLE MULTI LUMEN CENTR","code_information":[{"code":"2706071","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT CATHETERIZATION PRESSURE INJECTABLE QUAD LUMEN CANTRA","code_information":[{"code":"2706072","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER BI CAVAL DUAL LUMEN ECMO 13FR X 10CM","code_information":[{"code":"2706074","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":10759.0,"discounted_cash":6455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER BI CAVAL DUAL LUMEN ECMO 16FR X 13CM","code_information":[{"code":"2706075","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":10759.0,"discounted_cash":6455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER BI CAVAL DUAL LUMEN ECMO 19FR X 20CM","code_information":[{"code":"2706076","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":10759.0,"discounted_cash":6455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS VENO PERCUTANEOUS BICAVAL DUAL LUMEN ECMO","code_information":[{"code":"2706077","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":10759.0,"discounted_cash":6455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS VENO PERCUTANEOUS BICAVAL DUAL LUMEN ECMO","code_information":[{"code":"2706078","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":10759.0,"discounted_cash":6455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS CENTRAL DOUBLE LUMEN ANTIMICROBIAL POLYUR","code_information":[{"code":"2706082","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS DUAL LUMEN BLUE FLEXTIP PEDIATRIC","code_information":[{"code":"2706366","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS DUAL LUMEN WITH BLUE FLEXTIP 7.0F","code_information":[{"code":"2706367","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS CENTRAL PICC LINE SINGLE LUMEN WITH SHEAT","code_information":[{"code":"2706368","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PERIPHERAL MULTI LUMEN TWINCATH 16GA X 4.45CM","code_information":[{"code":"2706369","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC LINE PER Q PLUS SINGLE LUMEN EXCALIBUR INTR","code_information":[{"code":"2706370","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS DUAL LUMEN BLUE FLEXTIP PEDIATRIC","code_information":[{"code":"2706373","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATHETER GROSHONG DUAL LUMEN 9.5FR","code_information":[{"code":"2706375","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS SINGLE LUMEN HICKMAN WITH TISSUE","code_information":[{"code":"2706376","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC LINE PER Q PLUS SINGLE LUMEN EXCALIBUR INTR","code_information":[{"code":"2706377","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS BROVIAC SINGLE LUMEN WITH TISSUE","code_information":[{"code":"2706380","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS BROVIAC SINGLE LUMEN WITH TISSUE","code_information":[{"code":"2706381","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CARDIOVASCULAR HICKMAN DUAL LUMEN SURECUFF WITH","code_information":[{"code":"2706382","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS DUAL LUMEN WITH BLUE FLEXTIP FOR","code_information":[{"code":"2706384","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC LINE SINGLE LUMEN SILICONE NEONATAL 26GA X","code_information":[{"code":"2706385","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER PICC LINE INSERTION DUAL LUMEN 1.","code_information":[{"code":"2706386","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC POWER DUAL LUMEN WITH NITINOL GUIDEWIRE 5FR","code_information":[{"code":"2706387","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC POWER INJECTION TRIPLE LUMEN WITH PTFE RADS","code_information":[{"code":"2706388","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER POLY DOUBLE LUMEN PLATINUM 4FR","code_information":[{"code":"2706389","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC POWER INJECTION DUAL LUMEN WITH NURSING FUL","code_information":[{"code":"2706391","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER PICC LINE INSERTION SINGLE LUMEN","code_information":[{"code":"2706392","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER PICC POWER DUAL LUMEN SHERLOCK 5F","code_information":[{"code":"2706393","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATHETER PERQ FULL DOT POLY WITH MI AND TLS 3FR","code_information":[{"code":"2706394","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATHETER PICC POWER SINGLE LUMEN FULL NURSING 4FR","code_information":[{"code":"2706395","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER PICC POWER SINGLE LUMEN SHERLOCK","code_information":[{"code":"2706396","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER PICC POWER PER Q SOLO WITH SHERLO","code_information":[{"code":"2706397","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER TRIPLE LUMEN WITH SHERLOCK STYLET FULL TRAY POWE","code_information":[{"code":"2706398","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS COATED FOUR LUMEN 8.5FR X 20CM","code_information":[{"code":"2706399","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VASCULAR RETRIEVER DEVICE MERCI K MINI HELIX LOO","code_information":[{"code":"2706402","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":12906.0,"discounted_cash":7743.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER SET CENTRAL VENOUS ANTIMICROBIAL 4FR X 15CM","code_information":[{"code":"2706403","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS BROVIAC SINGLE LUMEN WITH TISSUE","code_information":[{"code":"2706404","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS HICKMAN TRIPLE LUMEN RIGHT ATRIAL","code_information":[{"code":"2706405","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER VESSEL UMBILICAL DOUBLE LUMEN STE","code_information":[{"code":"2707160","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLAR CERVICAL LOW CONTOUR FIRM DENSITY FOAM WITH STOCKI","code_information":[{"code":"2707410","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL THERMODILUTION OXIMETRY CONTINUOUS CARDI","code_information":[{"code":"2707841","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT REPAIR CATHETER SINGLE LUMEN HICKMAN 9.6FR","code_information":[{"code":"2707843","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN MULTI LUM LG BORE BL 12FRX6.0IN","code_information":[{"code":"2708139","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH VEN CTR 1LUM 5FRX20GAX15CM","code_information":[{"code":"2708140","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC LN PER Q + 1LUM EXCALIBUR 4FRX17GA","code_information":[{"code":"2708248","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":5802.0,"discounted_cash":3481.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 1LUM W/ SURECUFF TISS 8FR","code_information":[{"code":"2708249","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SET CATH CTR VEN MULTI LUM FLEXTIP 7FRX12IN","code_information":[{"code":"2708250","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC LN PER Q + 2LUM W/ INTRO FULL 4FR","code_information":[{"code":"2708251","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC LN PER Q + 1LUM W/ INTRO INTRMD 4FR","code_information":[{"code":"2708252","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN MULTI LUM BL FLEXTIP 5.5FRX8.0CM","code_information":[{"code":"2708254","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH GROSHONG 1LUM 5.5FR","code_information":[{"code":"2708256","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROC CATH CTR VEN 3LUM 7FRX20CM","code_information":[{"code":"2708257","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 2LUM BL FLEXTIP PEDI 4.0FRX5.0CM","code_information":[{"code":"2708258","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH MULTI LUM CVC ARROWHEAD PEDI 5.5FRX30CM","code_information":[{"code":"2708259","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN PICC TURBO FLO SET 4FRX60CM","code_information":[{"code":"2708260","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 4 LUM W/ BL FLX TP 8.5FR KT","code_information":[{"code":"2708261","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH POLY DBL LUM PERQCATH FULL 4FR","code_information":[{"code":"2708262","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROC CATH CTR VEN LN PRESS INJ 7FRX20CM","code_information":[{"code":"2708263","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 2LUM BL FLEXTIP 7.0FRX20CM","code_information":[{"code":"2708264","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN 3 LUM LG BORE CVP 12FRX16CM","code_information":[{"code":"2708266","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH 1LUM PEDI 4FRX65CM","code_information":[{"code":"2708272","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PARENTERAL NUTR BROVIAC DBL LUM 5FRX65CM","code_information":[{"code":"2708274","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX90X50CM","code_information":[{"code":"2708437","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX135X50CM","code_information":[{"code":"2708438","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX90X20CM","code_information":[{"code":"2708445","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX90X30CM","code_information":[{"code":"2708446","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX135X30CM","code_information":[{"code":"2708447","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX135X40CM","code_information":[{"code":"2708448","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX135X10CM","code_information":[{"code":"2708449","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX90X10CM","code_information":[{"code":"2708450","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX90X40CM","code_information":[{"code":"2708451","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH ANGIO SIZING ACCU VU 5FRX.038INX70CM","code_information":[{"code":"2708455","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH ANGIO SIZING ACCU VU OMNI FLSH X X 2CM","code_information":[{"code":"2708456","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH ANGIO SIZING ACCU VU OMNI FLSH 5FRX100CM","code_information":[{"code":"2708457","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PATTERN FLO THRU HUB 5FRX135X20CM","code_information":[{"code":"2708597","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INFUSE PROXIS 6TO8FR","code_information":[{"code":"2708611","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL POWERLOC INFUSE SFTY W/O Y 22GAX.75IN","code_information":[{"code":"2709172","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL POWERLOC INFUSE SFTY W/O Y 19GAX1.5IN","code_information":[{"code":"2709173","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL POWERLOC INFUSE SFTY W/O Y 19GAX.75IN","code_information":[{"code":"2709174","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH ANTIMICROB TRAY 5FRX5CM","code_information":[{"code":"2709610","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH TRAY 3LUM POLYURET ANTIMICROB 5FRX5CM","code_information":[{"code":"2709611","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER EPIDURAL OPEN TIP POLYMIDE 20GA X 100CM","code_information":[{"code":"2709650","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC POWERLINE DUAL LUMEN SURE CUFF TISSUE INGRO","code_information":[{"code":"2709656","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS TRIPLE LUMEN 25FR X 30CM","code_information":[{"code":"2709786","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER HICKMAN TRIFUSION INTERMEDIATE KIT 27CM X 12FR","code_information":[{"code":"2709811","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4576.0,"discounted_cash":2745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH HICKMN TRIFUSION INTRMD KT 23CMX12FR","code_information":[{"code":"2709861","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4576.0,"discounted_cash":2745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SET CTR VEN CATHERIZATION INDWELLING 16GAX8IN","code_information":[{"code":"2709873","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK IDENTIFIER SITE BIOP BREAST ATEC TRIMARK","code_information":[{"code":"2709952","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC POWERLINE 1LUM MICRO 5FR","code_information":[{"code":"2709967","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS DUAL LUMEN GROSHONG SURECUFF TISS","code_information":[{"code":"2710273","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS MULTI LUMEN WITH BLUE FLEXTIP 7FR","code_information":[{"code":"2710275","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 8 FR X 16 CM 2 LUMEN","code_information":[{"code":"2710277","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4725.0,"discounted_cash":2835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC POWER DUAL LUMEN SOLO 5FR X 70CM","code_information":[{"code":"2710279","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE RADIOLOGY POWERPICC SOLO NURSING FULL 4FR","code_information":[{"code":"2710280","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER PICC POWER DUAL LUMEN FULL 5FR","code_information":[{"code":"2710281","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER SET CENTRAL VENOUS TRIPLE LUMEN ANTIMICROBIAL SP","code_information":[{"code":"2710605","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS CENTRAL DOUBLE LUMEN 5FR X 5CM","code_information":[{"code":"2710606","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS CENTRAL TRIPLE LUMEN PEDIATRIC 5FR 12CM","code_information":[{"code":"2710634","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL LINE PRESSURE TRIPLE LUMEN 7FR","code_information":[{"code":"2710636","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS CENTRAL TRIPLE LUMEN 7FR X 16CM","code_information":[{"code":"2710637","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENOUS CENTRAL SINGLE LUMEN ANTIMICROBIAL 4FR X","code_information":[{"code":"2710638","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER CENTRAL VENOUS TRIPLE LUMEN KIT 7FR X 30CM","code_information":[{"code":"2711290","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER QUAD LUMEN SAFETY 8FR X 20CM","code_information":[{"code":"2711291","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARKER IDENTIFIER SITE BIOPSY BREAST ATEC TRIMARK 9GA X 3","code_information":[{"code":"2711763","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATHETER DUAL LUMEN MAC DISPOSABLE NON ARROWGARD BLU","code_information":[{"code":"2711900","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER CENTRAL VENOUS LINE PRESSURE INJE","code_information":[{"code":"2711901","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATHETER GROSHONG SINGLE LUMEN WITH SURECUFF TISSUE","code_information":[{"code":"2712580","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATHETER DUAL LUMEN MAC DISPOSABLE ARROWGARD BLUE 14","code_information":[{"code":"2712581","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL POWERLOC INFUSE SFTY W/O Y 20GAX1.5IN","code_information":[{"code":"2712618","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER INFUSION FOUNTAIN MATCHING WIRE 4FR X 30 X 135CM","code_information":[{"code":"2712631","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER INFUSION FOUNTAIN 4FR X 20 X 135CM","code_information":[{"code":"2712632","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER INFUSION FOUNTAIN MATCHING WIRE 4FR X 40 X 135CM","code_information":[{"code":"2712633","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER TRAY POLYURETHANE PERQ SINGLE LUMEN PICC TIP LOC","code_information":[{"code":"2712757","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL INFUSE SET INJ ST POWERLOC 20GAX0.75IN","code_information":[{"code":"2712913","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL INFUSE SET INJ ST POWERLOC MAX 20GAX1.5IN","code_information":[{"code":"2712914","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER VENTRICULAR RIVULET","code_information":[{"code":"2712988","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROCEDURE CATHETER PICC POWER SINGLE LUMEN MAXIMAL B","code_information":[{"code":"2713023","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY BARRIER POWER PICC DUAL 5FR","code_information":[{"code":"2713073","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL INFUSE SET INJ ST POWERLOC MAX 20GAX1.0IN","code_information":[{"code":"2713131","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY BARRIER MAXIMAL STERILE 6FR","code_information":[{"code":"2713141","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE POST OPERATIVE LITE TSCOPE HINGE LONG","code_information":[{"code":"2713175","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEEDLE LOCALIZATION BREAST LESION KOPANS MODIFIED MREYE 2","code_information":[{"code":"2713217","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEEDLE LOCALIZATION BREAST LESION KOPANS SPRING HOOK REIN","code_information":[{"code":"2713219","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEEDLE LOCALIZATION BREAST LESION SPRING HOOK KOPANS 20GA","code_information":[{"code":"2713220","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VEST HOLSTER 14V LARGE","code_information":[{"code":"2713313","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MODULE BATTERY CONTROLLER","code_information":[{"code":"2713315","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0507","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BATTERY UNIVERSAL CHARGER","code_information":[{"code":"2713319","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0507","type":"HCPCS"}],"standard_charges":[{"gross_charge":32231.0,"discounted_cash":19338.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MODULE DISPLAY THORATEC","code_information":[{"code":"2713321","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0484","type":"HCPCS"}],"standard_charges":[{"gross_charge":12906.0,"discounted_cash":7743.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VEST HOLSTER HEARTMATE II BLACK SMALL","code_information":[{"code":"2713322","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VEST HOLSTER HEARTMATE MEDIUM","code_information":[{"code":"2713323","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BATTERY LI ION CLIP SET 14V","code_information":[{"code":"2713325","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0497","type":"HCPCS"}],"standard_charges":[{"gross_charge":5802.0,"discounted_cash":3481.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BATTERY LI ION RECHARGEABLE 14V","code_information":[{"code":"2713327","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0506","type":"HCPCS"}],"standard_charges":[{"gross_charge":10759.0,"discounted_cash":6455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC POWER MODULE VENTRICULAR ASSIST DEVICE HEARTMATE II","code_information":[{"code":"2713330","type":"CDM"},{"code":"0272","type":"RC"},{"code":"Q0489","type":"HCPCS"}],"standard_charges":[{"gross_charge":34379.0,"discounted_cash":20627.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ADAPTER MODULE HEARTMATE II DISPLAY","code_information":[{"code":"2713462","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0507","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER PICC SINGLE LUMEN PERQCATH 1.9FR X 28CM","code_information":[{"code":"2713765","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PUMP PAIN MANAGEMENT ON Q SOAKER CATHETER EXPANSION T PEE","code_information":[{"code":"2713827","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEEDLE INFUSION SET INJECTABLE STERILE POWERLOC MAX 19GA","code_information":[{"code":"2713866","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT PORT ACCESS POWER LOC MAX WITHOUT Y SITE 19GA X 1.5IN","code_information":[{"code":"2713910","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IDENTIFIER BIOP SITE USE W/ EVIVA 10CM","code_information":[{"code":"2714243","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH KT CVP 1LUM 16GA X 16CM","code_information":[{"code":"2714397","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH THERMDILUT FIVE LUM SWAN 7.5FR X 110CM","code_information":[{"code":"2714641","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR LN JUG 3LUM W/ SHRP 7.0FR X 16CM","code_information":[{"code":"2714646","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV HICKMN 2LUM 9FR","code_information":[{"code":"2714647","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH DIAGOSTIC ANGIO 1LUM SS","code_information":[{"code":"2714648","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROC CATH PERIPH PICC POLY PQC 1LUM 3FR","code_information":[{"code":"2715009","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BIOP 2S SECURMARK F/ EVIVA 13 DEV","code_information":[{"code":"2715046","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN FLEXTIP BL KT 14GA X 20CM","code_information":[{"code":"2715733","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATH PICC PWR 1LUM MAX BARR 3FR CS/3","code_information":[{"code":"2715832","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATH PICC PWR 2LUM MAX BARR 4 FR CS/3","code_information":[{"code":"2715833","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATH PICC PWR 2LUM W/SAPIENS 5FR CS/3","code_information":[{"code":"2716206","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATH PICC PWR 1LUM W/SAPIENS 5FR CS/3","code_information":[{"code":"2716207","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY CATH PICC PWR 3LUM W/SAPIENS 6FR CS/3","code_information":[{"code":"2716208","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH MULTIFLX TDC 4 LUM 7FRX110CM","code_information":[{"code":"2716454","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR THERMDILUT 5 LUM RV 8FRX110CM","code_information":[{"code":"2716557","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN PULM 3 LUM SET 7FRX20CM","code_information":[{"code":"2716659","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR THERMDILUT OXMTR X PORT 8FRX110CM","code_information":[{"code":"2716661","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR THERMDILUT MULTIFLX 7FRX110CM","code_information":[{"code":"2716738","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR THERMDILUT PENTALUMEN 8FRX110CM","code_information":[{"code":"2716739","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH OXMTR PRESEP OLIGON NON LIDO 8.5FRX20CM","code_information":[{"code":"2716993","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE SWEDE O INNR LOK 8 BLK SM","code_information":[{"code":"2717311","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE SWEDE O INNR LOK 8 BLK MED","code_information":[{"code":"2717312","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB SHOULDER SLNG ABDUCT PILLW SUPR II BLK","code_information":[{"code":"2717340","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3660","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB SHOULDER SLNG ABDUCT PILLW SUPR II MED","code_information":[{"code":"2717341","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3660","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STRAP CLAV CONTOURRED SM","code_information":[{"code":"2717352","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3660","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STRAP CLAV CONTOURRED MED","code_information":[{"code":"2717353","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3660","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE SWEDE O INNR LOC 8 BLK XLARGE","code_information":[{"code":"2717359","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE SWEDE O INNR LOC 8 BLK LG","code_information":[{"code":"2717360","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE SWEDE O INNR LOC 8 BLK XSMALL","code_information":[{"code":"2717443","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE SWEDE O INNR LOC 8 BLK SM","code_information":[{"code":"2717444","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE SWEDE O INNR LOC 8 BLK MED","code_information":[{"code":"2717445","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT ANKLE FOOT ORTHOSIS PRE MOLD CUST FIT","code_information":[{"code":"2717455","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1904","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH BLN ANGIO THERMDILUT HEP COAT 6.0FRX80CM","code_information":[{"code":"2717614","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE SWEDE O INNR LOK 8 BLK XSMALL","code_information":[{"code":"2718187","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN L23 CM REV TUNNELED PALINDROME","code_information":[{"code":"2718193","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT THMB SPICA FRDM LT SM TO MED","code_information":[{"code":"2718201","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR 3LUM SAPIENS HI FLO 5FR CS/3","code_information":[{"code":"2718604","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH PICC PWR 3LUM NON SAPIENS NON CS/3","code_information":[{"code":"2718605","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH DOT MAX BARR 5 FR DL POWERPICC NURS FULL","code_information":[{"code":"2718617","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NDL BRACHYTHERAPY HDR MICK 15.5GAX25CM","code_information":[{"code":"2718620","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1715","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 2.6FX20CM 2LUM PICC","code_information":[{"code":"2718661","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 2.6FX50CM 2LUM PICC","code_information":[{"code":"2718662","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WRIST BRACE D RNG ROLYAN BLK RIGHTXLARGE","code_information":[{"code":"2718682","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV 3LUM MAXIMAL BARR SHERLOCK STYLET 5FR","code_information":[{"code":"2718861","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IDENTIFIER BIOP SITE SECUREMARK CELERO 12","code_information":[{"code":"2718911","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IDENTIFIER BIOP SITE SECUREMARK CELERO 12","code_information":[{"code":"2718912","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BIOP BREAST SITE IDENTIFIER SHP 2","code_information":[{"code":"2718913","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS XLG LT","code_information":[{"code":"2718951","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS","code_information":[{"code":"2718952","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS LT SM","code_information":[{"code":"2718953","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS LT MED","code_information":[{"code":"2718954","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS LT LG","code_information":[{"code":"2718955","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS RT MED","code_information":[{"code":"2718956","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS RT LG","code_information":[{"code":"2718957","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ABDUCT THMB LPLK STRAPS RT SM","code_information":[{"code":"2718958","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ORTHOTIC ATHL BLANK REARFOOT WEDGE","code_information":[{"code":"2719008","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST & THMB SPICA POLYFLEX II MED","code_information":[{"code":"2719021","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STRAP CLAV CONTOURRED LG","code_information":[{"code":"2719069","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST COCKUP LT MED","code_information":[{"code":"2719126","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP THMB ELAST RT MED","code_information":[{"code":"2719134","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST RADL BAR COCK-UP MED 1/8IN","code_information":[{"code":"2719257","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK FIX ANKLE PROF HI MED","code_information":[{"code":"2719294","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE ADD EXTREM LO AFO LIMITED MOTION","code_information":[{"code":"2719371","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L2200","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV HICKMN SURECUFF 2LUM 7FRX65CM","code_information":[{"code":"2719378","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH THERMDILUT OPTICATH OXMTR 8FRX110CM","code_information":[{"code":"2719809","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH THERMDILUT OPTICATH PA OXMTR 8FRX110CM","code_information":[{"code":"2719810","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH THERMDILUT OPTI-Q OXMTR 8FRX110CM","code_information":[{"code":"2719811","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH THERMDILUT OPTICATH PA OXMTR 5.5FRX75CM","code_information":[{"code":"2719812","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH THERMDILUT OXMTR 8FRX110CM","code_information":[{"code":"2719813","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC SAPIENS 2LUM REV TAPR 5FR","code_information":[{"code":"2719921","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE LUMBR THOR","code_information":[{"code":"2720338","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BNDG DRSG DA KT","code_information":[{"code":"2720911","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2720911","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BNDG DRSG DBL LEG KT","code_information":[{"code":"2720913","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2720913","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BNDG DRSG SING ARM KT","code_information":[{"code":"2720915","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2720915","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BNDG DRSG SING LEG KT","code_information":[{"code":"2720916","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2720916","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT TIB FIBULA POSTR KNEE LEN UNIV MED","code_information":[{"code":"2721004","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L2999","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC NITINOL 3LUM 5FRX135CM","code_information":[{"code":"2721009","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":7727.0,"discounted_cash":4636.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB SHOULDER ABDUCT PILLW SLNG SHOT 2 LG","code_information":[{"code":"2721054","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3660","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE POST OPER LITE SHRT","code_information":[{"code":"2721148","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1831","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE POST OPER LITE LNG","code_information":[{"code":"2721149","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1831","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BNDR ABD SOLID PANL LF ELAST HK LP NS 48X10IN","code_information":[{"code":"2721200","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0626","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE POST OPER QUICK FIT THGH 22 TO","code_information":[{"code":"2721201","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IDENTIFIER BIOP SITE BREAST ULTRASND 12GA","code_information":[{"code":"2721328","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK TISS ULTR CLIP II TI 17GAX10CMX3.0MM","code_information":[{"code":"2721329","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IDENTIFIER BIOP SITE BREAST ULTRASND 8GA","code_information":[{"code":"2721330","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IDENTIFIER BIOP SITE BREAST MRI GUIDED","code_information":[{"code":"2721331","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BIOP 2ND SHP SECURMARK F/ EVIVA 10 DEV","code_information":[{"code":"2721332","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BIOP SECURMARK F/ EVIVA 10 DEV","code_information":[{"code":"2721333","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IDENTIFIER BIOP SITE USE EVIVA TRIMARK 10CM","code_information":[{"code":"2721335","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BIOP 2S SECURMARK EVIVA 13","code_information":[{"code":"2721337","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BIOP BREAST SITE IDENTIFIER SHP 2","code_information":[{"code":"2721338","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK TISS IDENTIFIER BIOP SITE SECUREMARK","code_information":[{"code":"2721339","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK TISS IDENTIFIER BIOP SITE SECUREMARK","code_information":[{"code":"2721340","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE FOOT ORTHOSIS","code_information":[{"code":"2721457","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1930","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE HIP ABDUCT ORTHOSIS CUST FIT","code_information":[{"code":"2721504","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1686","type":"HCPCS"}],"standard_charges":[{"gross_charge":6765.0,"discounted_cash":4059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC SOLO 3LUM MAXIMAL BARR 6FR","code_information":[{"code":"2721557","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3820.0,"discounted_cash":2292.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV GROSHONG NXT PICC 1LUM TRAY 4FR","code_information":[{"code":"2721558","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT KNEE SUPR FM MSH WEB STRAPS LG 22IN","code_information":[{"code":"2721569","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT KNEE SUPR FM MSH WEB STRAPS MED 19IN","code_information":[{"code":"2721570","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BIOP SECURMARK EVIVA 13","code_information":[{"code":"2721576","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":5596.0,"discounted_cash":3357.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LIFT HEEL ADJ A LIFT SM","code_information":[{"code":"2721609","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3332","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE AIRCAST SP WALK MED","code_information":[{"code":"2721623","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE AIRCAST SP WALK LG","code_information":[{"code":"2721624","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE AIRCAST FM WALK LG","code_information":[{"code":"2721627","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP ANKLE SURROUND FLOAM BLDR REG 10IN","code_information":[{"code":"2721629","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT POST OPER DARCO ALLPURP APB CLS TOE MED","code_information":[{"code":"2721630","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE SM 13IN","code_information":[{"code":"2721650","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV FM MED DENS SM 3X18 1/2IN 11 16IN","code_information":[{"code":"2721652","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV FM MED DENS LG 4 1/2X22 1/2 20IN","code_information":[{"code":"2721653","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV CONTUR LG","code_information":[{"code":"2721654","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT FOOT CAST DLX VINYL LTX MED 11X4.75IN","code_information":[{"code":"2721735","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT FOOT CAST SANDLE DLX VINYL MED 11X4.75IN","code_information":[{"code":"2721736","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST FM TRICOT MALL ALUM 8.5X10IN","code_information":[{"code":"2721763","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST FM TRICOT MALL ALUM 7.5X10IN","code_information":[{"code":"2721764","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST FM TRICOT MALL ALUM 8.5X10IN","code_information":[{"code":"2721765","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV ANTISEP COAT 3LUM KT 7FRX20CM","code_information":[{"code":"2721773","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST METACARPAL PAD LT LG","code_information":[{"code":"2721777","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3917","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING LG","code_information":[{"code":"2721784","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING MED","code_information":[{"code":"2721785","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING SM","code_information":[{"code":"2721786","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING XL","code_information":[{"code":"2721787","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING XS","code_information":[{"code":"2721788","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING XXL","code_information":[{"code":"2721789","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING XXXL","code_information":[{"code":"2721790","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE WRPARND HING XXXXLARGE","code_information":[{"code":"2721791","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC SOLO 2 SHERLOCK STYLET 5FR","code_information":[{"code":"2722182","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC SOLO 3LUM SHERLOCK 6FR","code_information":[{"code":"2722183","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC SOLO 2LUM SHERLOCK 5FR","code_information":[{"code":"2722192","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV GROSHONG NXT CLEARVUE PICC 1LUM 4FR","code_information":[{"code":"2722193","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV PICC POWERGROSHONG NXT 2LUM 5FRX45CM","code_information":[{"code":"2722194","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV GROSHONG NXT PICC TLS 2LUM TRAY 5FR","code_information":[{"code":"2722195","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMBOLIZER KNEE XL 16IN","code_information":[{"code":"2722225","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE QUICK FIT VELCR STRAPS 22INX22IN","code_information":[{"code":"2722288","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH INTERVENTIONAL TWINCATH 18GAX1.75IN","code_information":[{"code":"2722302","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV FM MED DENS MED 4X20IN 13 TO 18IN","code_information":[{"code":"2722306","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV FM MED DENS MED LNG 4X23IN 16 21IN","code_information":[{"code":"2722308","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV FM MED DENS SM LNG 3X22IN 15 20IN","code_information":[{"code":"2722309","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV FM MED DENS XL LNG 2X24IN 17 22IN","code_information":[{"code":"2722310","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV LF CHIN REST TRACH OPEN ADJ STRAP","code_information":[{"code":"2722312","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAY PROC THORACENT TURKEL SFTY ST 8FRX9CM","code_information":[{"code":"2722387","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE FOOT ORTHOSIS CARBN FIBR RIGD","code_information":[{"code":"2722459","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1932","type":"HCPCS"}],"standard_charges":[{"gross_charge":5705.0,"discounted_cash":3423.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV 1LUM STR J 5FRX16GAX3MMX20CM","code_information":[{"code":"2722823","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE PROSTHETIC SHRINKER ABOVE KNEE","code_information":[{"code":"2722825","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8460","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE DARCO LG","code_information":[{"code":"2722916","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP BREAST BRA CAREFIX MASTCTMY MICROFIBER","code_information":[{"code":"2722927","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP BREAST BRA CAREFIX MASTCTMY MED","code_information":[{"code":"2722928","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP BREAST BRA CAREFIX MASTCTMY XL","code_information":[{"code":"2722929","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP BREAST BRA CAREFIX MASTCTMY XXL","code_information":[{"code":"2722930","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB SHOULDER ABDUCT PILLW ULTRASLING MED","code_information":[{"code":"2722989","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT KNEE SUPR FM MSH WEB STRAPS XL 26IN","code_information":[{"code":"2722991","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK FOOT AIRCAST SP SM","code_information":[{"code":"2722995","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1906","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST COCKUP MALL ALUM LPLK RT 7.5X6IN","code_information":[{"code":"2722996","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK FOOT AIRCAST FM MED","code_information":[{"code":"2722998","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1906","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WRP WRIST COMPRSS SUPP CLTH LINER NEOPRN","code_information":[{"code":"2723000","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE CAST CANVS ROCKR SOLE NAVY LG","code_information":[{"code":"2723036","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE CAST CANVS ROCKR SOLE NAVY MED","code_information":[{"code":"2723037","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE CAST CANVS ROCKR SOLE NAVY SM","code_information":[{"code":"2723038","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE CAST CANVS ROCKR SOLE NAVY XL","code_information":[{"code":"2723039","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST COCKUP MALL ALUM LPLK RT 6.5X6IN","code_information":[{"code":"2723040","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH MULTI LUM LG BORE 12FRX16CM","code_information":[{"code":"2723182","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT SURG POST OPER AMBUL CUST","code_information":[{"code":"2723253","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INTRO BIOP SITE IDENTIFIER VABB SYSTEMS 9GA","code_information":[{"code":"2723257","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP THMB METAGRIP LT SZ 1","code_information":[{"code":"2723406","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP THMB METAGRIP LT SZ 2","code_information":[{"code":"2723407","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP THMB METAGRIP LT SZ 3","code_information":[{"code":"2723408","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP THMB METAGRIP RT SZ 1","code_information":[{"code":"2723409","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP THMB METAGRIP RT SZ 2","code_information":[{"code":"2723410","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP THMB METAGRIP RT SZ 3","code_information":[{"code":"2723411","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV HICKMN VITACUFF SURECUFF 10FRX97CM","code_information":[{"code":"2723432","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV HICKMN VITACUFF SURECUFF 12.5FRX90CM","code_information":[{"code":"2723433","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST FM TRICOT MALL ALUM 7.5X10IN","code_information":[{"code":"2723446","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST FM TRICOT MALL ALUM 6.5X10IN","code_information":[{"code":"2723447","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT THMB ABDUCT COMFRT COOL LT LG","code_information":[{"code":"2723476","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT THMB ABDUCT COMFRT COOL RT LG","code_information":[{"code":"2723477","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE FOOT DARCO MED SURG MENS SM","code_information":[{"code":"2723509","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STRAP CLAV CONTOURRED XL","code_information":[{"code":"2723514","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT FOOT POST OPER DARCO APB HI LF CLS 13","code_information":[{"code":"2723534","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT FOOT POST OPER DARCO APB HI LF CLS 14","code_information":[{"code":"2723535","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT FOOT POST OPER DARCO APB HI LF CLS 10","code_information":[{"code":"2723536","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE P OP TSCOPE PREMIER FULL FM","code_information":[{"code":"2723545","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SLNG SHOULDERULTRASLING II ABDUCT PILLW 13IN","code_information":[{"code":"2723547","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SLNG SHOULDERULTRASLING II ABDUCT PILLW 13IN","code_information":[{"code":"2723548","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE LG 16IN","code_information":[{"code":"2723640","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE LG 19.5IN","code_information":[{"code":"2723641","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE MED 19.5IN","code_information":[{"code":"2723642","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE UNIV MED 16.5IN","code_information":[{"code":"2723643","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE XL 13IN","code_information":[{"code":"2723644","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV PWR HICKMN 2LUM SURECUFF TISS 9.5FR","code_information":[{"code":"2723697","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4725.0,"discounted_cash":2835.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MARK BREAST TISS ULTRACLIP 2 TRGGR 17GAX10CM","code_information":[{"code":"2723733","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT THMB COMFRT COOL PERF NEOPRN TERRY","code_information":[{"code":"2723744","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST COMFRT COOL THMB CMC LT MED","code_information":[{"code":"2723745","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST COMFRT COOL THMB CMC RT MED","code_information":[{"code":"2723747","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP WRIST TENS STRAP LT XL","code_information":[{"code":"2723752","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP WRIST TENS STRAP RT XL","code_information":[{"code":"2723753","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERHOHN POLYRETHANE 2LUM 6FR","code_information":[{"code":"2723789","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE SPRINT LF CLS CELL FM GEL 10.5IN","code_information":[{"code":"2723793","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR EXTRIC EAGAN II LF 1 PC FLIP CHIN PC","code_information":[{"code":"2723838","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0140","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR EXTRIC EAGAN II LF 1 PC FLIP CHIN PC","code_information":[{"code":"2723839","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0140","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV QUAD LUM VANTEX TRAY 8.5FRX20CM","code_information":[{"code":"2723890","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR EXTRIC ADJ STIFFNECK SELECT","code_information":[{"code":"2723923","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0140","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST COMFRT COOL THMB CMC LT LG","code_information":[{"code":"2723940","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT FINGER REV KNCKL SS FELT XSMALL-EA/1","code_information":[{"code":"2724038","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT FINGER REV KNCKL SS FELT PAD ADJ XL","code_information":[{"code":"2724039","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE FOOT POST OPER DLX.1 LF TRICOT LN PAD 10","code_information":[{"code":"2724044","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ORTHOSIS SHOULDER UNILATERAL MFC RT 13IN-EA/1","code_information":[{"code":"2724102","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE STIRUP BIL BL SM","code_information":[{"code":"2724573","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK FOOT PNEUM LF SEMIRIGID PREINFLATED 11","code_information":[{"code":"2724586","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE KNEE ORTHOSIS FIT PREFABRICATED CUST","code_information":[{"code":"2724638","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":5705.0,"discounted_cash":3423.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK FOOT SP SHRT PNEUM LF POLYPRP 11 TO15","code_information":[{"code":"2724694","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV MULTI-LUMEN ARROW-HOWES LG 12FRX16CM","code_information":[{"code":"2724722","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC SOLO 1LUM MAXIMAL 4FR","code_information":[{"code":"2724723","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC 3LUM HI FLO SOLO 2 5FR","code_information":[{"code":"2724724","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CV POWERPICC SOLO 2LUM SHERLOCK 5FRX2FT","code_information":[{"code":"2724725","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ORTHOSIS SHOULDER UNILT MFC RT SM 9 TO 13IN","code_information":[{"code":"2724742","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT WRIST COCKUP RT LG","code_information":[{"code":"2724756","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB SHOULDER PILLW ABDUCT WRIST HUM MED","code_information":[{"code":"2724758","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3960","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE CUST SM 13IN","code_information":[{"code":"2724760","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE CUST XL 16IN","code_information":[{"code":"2724761","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER CLS HEEL LT CUST SM","code_information":[{"code":"2724764","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER CLS HEEL LT CUST MED","code_information":[{"code":"2724765","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER CLS HEEL LT CUST LG","code_information":[{"code":"2724766","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT THMB PERF VINYL UNIV","code_information":[{"code":"2724769","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ANKLE AIRCAST AIRSPORT LTX LT MED","code_information":[{"code":"2724785","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4350","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOB KNEE UNIV SM 16IN","code_information":[{"code":"2724799","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BELT PELVIS SI-LOC SACROILIAC LF 2 HK LP MED","code_information":[{"code":"2724824","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0621","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE HND METACARPAL XL","code_information":[{"code":"2724878","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3917","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KT PER Q CATH PICC RETRV SNR SHEATH SIL 20MM","code_information":[{"code":"2724916","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4576.0,"discounted_cash":2745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO ALLPURP BLK XS","code_information":[{"code":"2724957","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BELT PELVIS SI-LOC SACROILIAC LF 2 HK LP XL","code_information":[{"code":"2724959","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0621","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT THMB ABDUCT COMFRT COOL RT MED","code_information":[{"code":"2724966","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE LUMBR ORTHOSIS SAG CTRL STAYS RIGD ANT","code_information":[{"code":"2725027","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0627","type":"HCPCS"}],"standard_charges":[{"gross_charge":4576.0,"discounted_cash":2745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH OXMTR CV OPTI SVO2 EXPANDED KT","code_information":[{"code":"2725419","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE ELBOW VULKAN EPI LF LG 12.2 TO 13.4IN","code_information":[{"code":"2725427","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE FOOT POST OPER MEDSURG LTX NYL OPEN SQ","code_information":[{"code":"2725429","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN MULTI PORT W/ SIDEHOLE 14GAX20CC","code_information":[{"code":"2725514","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP WRIST R SFT RT SM 6.5X7.25IN","code_information":[{"code":"2725539","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP WRIST TENS STRAP LT SM","code_information":[{"code":"2725658","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUPP WRIST TENS STRAP RT SM","code_information":[{"code":"2725659","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE WRIST ROLYAN LF ADJ ALUM BAR D-RING","code_information":[{"code":"2725661","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN MULTI-LUMEN BL FLEXTIP 7FRX8IN","code_information":[{"code":"2725723","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN POWERGROSHONG PICC SING 5FRX45CM","code_information":[{"code":"2725797","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4576.0,"discounted_cash":2745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH CTR VEN POWERGROSHONG PICC SING 5FRX55CM","code_information":[{"code":"2725798","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4576.0,"discounted_cash":2745.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO ALL PURPUSE XL","code_information":[{"code":"2725844","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER DARCO ALLPURP LG","code_information":[{"code":"2725845","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT ANKLE PNEUM FP WALK LF FM AIR COMPRT","code_information":[{"code":"2725862","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK WALK FP WALK LF PLSTC FM AIRCELL SM","code_information":[{"code":"2725863","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT ANKLE PNEUM FP WALK LF FM AIR COMPRT","code_information":[{"code":"2725864","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMOBOLIZER KNEE TERRY CLTH LN ROLYAN BL MED","code_information":[{"code":"2725891","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT THMB COMFRT COOL CMC RT LG","code_information":[{"code":"2725990","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SOCK PROSTHETIC MULTI PLY BELOW KNEE CUST","code_information":[{"code":"2725996","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8420","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT 2 PROCESSOR 2 NUCLEUS 6 SOUND CP910 CP920","code_information":[{"code":"2726023","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L8619","type":"HCPCS"}],"standard_charges":[{"gross_charge":55185.0,"discounted_cash":33111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT CLAV HVY PAD MED","code_information":[{"code":"2726077","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT WALK AIRCAST AIRSELECT SHRT XL","code_information":[{"code":"2726130","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT HND NEUT POS SELF ADH STRAP LT LG","code_information":[{"code":"2726136","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT HND NEUT POS SELF ADH STRAP RT LG","code_information":[{"code":"2726137","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT POST OPER DARCO ALLPURP APB CLS TOE SM","code_information":[{"code":"2726159","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT CAST TCC-EZ TOT CONTCT FOOT LGHTWT LG","code_information":[{"code":"2726616","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT CAST TCC-EZ TOT CONTCT FOOT LGHTWT REG","code_information":[{"code":"2726617","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT CAST TCC-EZ TOT CONTCT FOOT LGHTWT","code_information":[{"code":"2726618","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT CAST TCC-EZ TOT CONTCT FOOT LGHTWT XL","code_information":[{"code":"2726619","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT CAST TCC-EZ TOT CONTCT FOOT LGHTWT XL","code_information":[{"code":"2726620","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK ANKLE LPROF FIX SM","code_information":[{"code":"2726639","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT REPAIR CATH CV HICKMN CMPLT EXT 7FR","code_information":[{"code":"2726660","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH MIDLINE PWR GLD PERPHERAL IV IV 10CM","code_information":[{"code":"2726679","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT CATH BASIC POWERGLIDE MIDLINE 20GA 8CM","code_information":[{"code":"2726680","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT CATH POWERGLIDE 18G 8CM NHPL MED SURG","code_information":[{"code":"2726681","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT CATH POWERGLIDE 18G 10CM NHPL MED SURG","code_information":[{"code":"2726682","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC KIT CATH CV TWO-LUMEN BL FLEXTIP 7FRX8IN","code_information":[{"code":"2726711","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACE THMB TITN LF FELT NYL PALMAL DORSAL 9IN","code_information":[{"code":"2726758","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT WALKER SMALL VARSITY","code_information":[{"code":"2726768","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT WALKER MEDIUM VARSITY","code_information":[{"code":"2726770","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BOOT WALKER LARGE VARSITY","code_information":[{"code":"2726771","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK ANKLE LF FIBR NYL PLSTC SHLL HEEL PADS 7","code_information":[{"code":"2726772","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK ANKLE LF FIBR NYL PLSTC SHLL HEEL 11","code_information":[{"code":"2726773","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK ANKLE LF FIBR NYL PLSTC SHLL HEEL PADS","code_information":[{"code":"2726774","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WALK ANKLE MAXTRAX AIR PNEUM LINER CONTCT","code_information":[{"code":"2726775","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH VEN LEONARD SURECUFF CTR 2LUM 10FRX90CM","code_information":[{"code":"2726813","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV CLINIC LF MD DENS FM COTN 3X24IN","code_information":[{"code":"2726815","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV UNIV RETAIL 2IN","code_information":[{"code":"2726818","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLNT HND GERIATRIC ORTHOSIS W/ MED 14IN","code_information":[{"code":"2726833","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GERIATRIC HND ORTHOSIS W/O FINGER SEPARATORS","code_information":[{"code":"2726834","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ORTHOSIS HND GERIATRIC W/O FINGER SEPARATORS","code_information":[{"code":"2726835","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ORTHOSIS HND GERIATRIC W/O FINGER MED","code_information":[{"code":"2726836","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV CARDINAL SERP MD DENS FM 3.25X19IN","code_information":[{"code":"2726839","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV CLINIC LF MD DENS FM COTN 4X24IN","code_information":[{"code":"2726840","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COLLR CERV CLINIC LF MD DENS FM COTN 2.5X24IN","code_information":[{"code":"2726841","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L0120","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH THERMDILUT SWAN-GANZ HI-SHORE 7FRX110CM","code_information":[{"code":"2726886","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SHOE POST OPER SOFTIE LF TRICOT FM OPEN MED","code_information":[{"code":"2726898","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BNDG DRSG DBL 1/2 LEG KT","code_information":[{"code":"2727197","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2727197","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BNDG DRSG SING 1/2 LEG KT","code_information":[{"code":"2727198","type":"CDM"},{"code":"0272","type":"RC"},{"code":"2727198","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER POWERGLIDE PRO MIDLINE 18G 10CM","code_information":[{"code":"2727444","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER POWERGLIDE PRO MIDLINE 20G 10CM","code_information":[{"code":"2727445","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER IV 18GA 10CM MIDLINE C1751","code_information":[{"code":"2727448","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER IV 20GA 10CM MIDLINE C1751","code_information":[{"code":"2727449","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ULTRACLIP TISSUE MARKER 17G 10CM","code_information":[{"code":"2727452","type":"CDM"},{"code":"0272","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER POWERGLIDE PRO 18G 10CM","code_information":[{"code":"2727470","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATHETER POWERGLIDE PRO 20G 10CM","code_information":[{"code":"2727471","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VENIPUNCTURE-BLOOD DRAW","code_information":[{"code":"3000001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":25.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC VENIPUNCTURE-CAPILLARY","code_information":[{"code":"3000002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":25.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 36592 BLOOD COLLECTION, VENOUS CATHETER","code_information":[{"code":"3000003","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":148.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ARTERIAL PUNCTURE, W/DRAW BLOOD FOR DX","code_information":[{"code":"3000004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BASIC METABOLIC PANEL W TOTAL CALCIUM","code_information":[{"code":"3000007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GENERAL HEALTH PANEL","code_information":[{"code":"3000008","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1348.0,"discounted_cash":808.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":713.0,"discounted_cash":427.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"3000009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":212.0,"discounted_cash":127.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COMPREHENSIVE METABOLIC PANEL","code_information":[{"code":"3000010","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":322.0,"discounted_cash":193.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC OBSTETRIC PANEL","code_information":[{"code":"3000011","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":898.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":800.0,"discounted_cash":480.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"3000012","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":162.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RENAL FUNCTION PANEL","code_information":[{"code":"3000013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":267.0,"discounted_cash":160.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH ACUTE HEPATITIS PANEL LAB TEST","code_information":[{"code":"3000014","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":1036.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":634.0,"discounted_cash":380.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEPATIC FUNCTION PANEL","code_information":[{"code":"3000015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":194.0,"discounted_cash":116.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ASSAY OF AMIKACIN LAB TEST","code_information":[{"code":"3000019","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":303.0,"discounted_cash":181.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY, CARBAMAZEPINE, TOTAL","code_information":[{"code":"3000022","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH CYCLOSPORINE LAB TEST","code_information":[{"code":"3000024","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":391.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":634.0,"discounted_cash":380.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF ETHOSUXIMIDE ETHSX","code_information":[{"code":"3000028","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"3000029","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":361.0,"discounted_cash":216.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF LITHIUM","code_information":[{"code":"3000032","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":209.0,"discounted_cash":125.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PHENOBARBITAL","code_information":[{"code":"3000034","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PHENYTOIN, TOTAL","code_information":[{"code":"3000035","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":253.0,"discounted_cash":151.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF PHENYTOIN, FREE PNTFT","code_information":[{"code":"3000036","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":436.0,"discounted_cash":261.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH RAPAMYCIN  LEVEL LAB TEST","code_information":[{"code":"3000040","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":344.0,"discounted_cash":206.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH TACROLIMUS, FK506 LAB TEST","code_information":[{"code":"3000042","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":821.0,"discounted_cash":492.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF THEOPHYLLINE","code_information":[{"code":"3000043","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF TOBRAMYCIN","code_information":[{"code":"3000044","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":311.0,"discounted_cash":186.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"3000046","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":364.0,"discounted_cash":218.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC QUANTITATIVE ASSAY, DRUG","code_information":[{"code":"3000047","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":303.0,"discounted_cash":181.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINALYSIS, AUTO W/SCOPE","code_information":[{"code":"3000050","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":84.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINALYSIS, AUTO W/O SCOPE","code_information":[{"code":"3000052","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINALYSIS REAGENT STRIP","code_information":[{"code":"3000053","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":152.0,"discounted_cash":91.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINALYSIS; MICROSCOPIC ONLY","code_information":[{"code":"3000054","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":152.0,"discounted_cash":91.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINE PREGNANCY TEST, QUAL","code_information":[{"code":"3000055","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":150.0,"discounted_cash":90.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINALYSIS, VOLUME MEASURE","code_information":[{"code":"3000056","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ACETONE/OTHER KETONE BODIES, SERUM","code_information":[{"code":"3000058","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82009","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":89.0,"discounted_cash":53.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BETA HYDROXYBUTYRATE LAB TEST","code_information":[{"code":"3000059","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ALBUMIN; SERUM, PLASMA, WHOLE BLOOD","code_information":[{"code":"3000063","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ALBUMIN MICROALBUMIN, QUANT NON URINE","code_information":[{"code":"3000064","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":136.0,"discounted_cash":81.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE","code_information":[{"code":"3000065","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":73.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":122.0,"discounted_cash":73.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF ALDOSTERONE ALDS","code_information":[{"code":"3000068","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":488.0,"discounted_cash":292.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ALPHA-1-ANTITRYPSIN,TOTAL LAB TEST","code_information":[{"code":"3000069","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ALPHA-FETOPROTEIN, SERUM","code_information":[{"code":"3000071","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY, AMINOLEVULINIC ACID ALAUR","code_information":[{"code":"3000076","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":394.0,"discounted_cash":236.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC AMINO ACIDS, QUANTITATIVE","code_information":[{"code":"3000078","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":468.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":713.0,"discounted_cash":427.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC AMMONIA","code_information":[{"code":"3000079","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC AMNIOTIC FLUID SCAN","code_information":[{"code":"3000080","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82143","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC AMYLASE","code_information":[{"code":"3000082","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PED PROF ANDROSTENEDIONE","code_information":[{"code":"3000083","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANGIOTENSIN I ENZYME TEST FACEC","code_information":[{"code":"3000084","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":184.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC BETA-2 MICROGLOBULIN LAB TEST","code_information":[{"code":"3000089","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":120.0,"discounted_cash":72.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BILIRUBIN, TOTAL","code_information":[{"code":"3000090","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BILIRUBIN; DIRECT","code_information":[{"code":"3000091","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD, OCCULT,QUALITATIVE","code_information":[{"code":"3000093","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD, OCCULT, PEROXIDASE,QUAL OTHER","code_information":[{"code":"3000094","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":124.0,"discounted_cash":74.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD, OCCULT PEROX, QUAL, FECES,1 SPEC","code_information":[{"code":"3000095","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":91.0,"discounted_cash":54.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC QUALITATIVE FECAL BLOOD IMMUNOASSAY","code_information":[{"code":"3000096","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":102.0,"discounted_cash":61.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CADMIUM FOR OCCUPATIONAL MONITORING; CDOM","code_information":[{"code":"3000097","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF VITAMIN D","code_information":[{"code":"3000098","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":250.0,"discounted_cash":150.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CALCIUM; TOTAL","code_information":[{"code":"3000100","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IONIZED CALCIUM","code_information":[{"code":"3000101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":214.0,"discounted_cash":128.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF CALCIUM IN URINE","code_information":[{"code":"3000102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY, BLOOD CARBON DIOXIDE","code_information":[{"code":"3000106","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":98.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CARBON MONOXIDE, QUANTITATIVE","code_information":[{"code":"3000107","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":280.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA)","code_information":[{"code":"3000108","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ASSAY OF CERULOPLASMIN LAB TEST","code_information":[{"code":"3000113","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHLORIDE; BLOOD","code_information":[{"code":"3000115","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE CHLORIDE","code_information":[{"code":"3000116","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHLORIDE; FLUID","code_information":[{"code":"3000117","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHOLESTEROL, SERUM, TOTAL","code_information":[{"code":"3000119","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PSEUDOCHOLINESTERASE, TOTAL; PCHES","code_information":[{"code":"3000120","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":408.0,"discounted_cash":244.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TOTAL CORTISOL","code_information":[{"code":"3000132","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":311.0,"discounted_cash":186.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO GC/MS,QUANT,SINGLE STATIONARY PHASE FCANC","code_information":[{"code":"3000134","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":292.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":460.0,"discounted_cash":276.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CREATINE KINASE (CPK); TOTAL","code_information":[{"code":"3000136","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CREATINE KINASE (CPK); MB FRAC ONLY","code_information":[{"code":"3000138","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":193.0,"discounted_cash":115.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CREATININE; BLOOD","code_information":[{"code":"3000139","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CREATININE, OTHER SOURCE","code_information":[{"code":"3000140","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":87.0,"discounted_cash":52.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CREATININE CLEARANCE TEST","code_information":[{"code":"3000141","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ASSAY OF CRYOGLOBULIN LAB TEST","code_information":[{"code":"3000143","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":277.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYANOCOBALAMIN (VITAMIN B-12)","code_information":[{"code":"3000145","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":206.0,"discounted_cash":123.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH DHEA-S LAB TEST","code_information":[{"code":"3000149","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.0,"discounted_cash":311.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":480.0,"discounted_cash":288.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PED PROF DEOXYCORTISOL","code_information":[{"code":"3000150","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ERYTHROPOIETIN EPO","code_information":[{"code":"3000161","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"3000162","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":304.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":408.0,"discounted_cash":244.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY ESTROGENS FRACTIONATED ESTF","code_information":[{"code":"3000163","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":136.0,"discounted_cash":81.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FAT/LIPIDS FECES QUAL","code_information":[{"code":"3000168","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FERRITIN","code_information":[{"code":"3000172","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FETAL FIBRONECTIN, SEMI-QUANT","code_information":[{"code":"3000173","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.0,"discounted_cash":852.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1237.0,"discounted_cash":742.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FOLIC ACID; SERUM","code_information":[{"code":"3000174","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO RBC FOLIC ACID LAB TEST","code_information":[{"code":"3000175","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH IGA, IGD, IGG, IGM,EA LAB TEST","code_information":[{"code":"3000179","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH IGE LAB TEST","code_information":[{"code":"3000180","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":308.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD PH","code_information":[{"code":"3000182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD GASES: PH, PO2, & PC02","code_information":[{"code":"3000183","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":462.0,"discounted_cash":277.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GASES, BLOOD W/ DIRECT O2 SAT","code_information":[{"code":"3000184","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":361.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":552.0,"discounted_cash":331.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GASES, BLOOD, O2 SAT ONLY","code_information":[{"code":"3000185","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GLUCOSE; CSF, OTHER FLUID","code_information":[{"code":"3000189","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":152.0,"discounted_cash":91.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GLUCOSE; QUANT, BLOOD","code_information":[{"code":"3000190","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":78.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GLUCOSE; POST DOSE","code_information":[{"code":"3000192","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GLUCOSE TOLERANCE TEST","code_information":[{"code":"3000193","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":558.0,"discounted_cash":334.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GTT EACH ADDITIONAL SPECIMEN BEYOND 3 SPECIMENS","code_information":[{"code":"3000194","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF GGT, GAMMA GT","code_information":[{"code":"3000196","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GONADOTROPIN (FSH)","code_information":[{"code":"3000198","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":305.0,"discounted_cash":183.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GONADOTROPIN (LH)","code_information":[{"code":"3000199","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY, GROWTH HORMONE (HGH)","code_information":[{"code":"3000200","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":162.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":253.0,"discounted_cash":151.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HAPTOGLOBIN; QUANTITATIVE","code_information":[{"code":"3000201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":490.0,"discounted_cash":294.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COBALT QUANT COS","code_information":[{"code":"3000203","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":397.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":642.0,"discounted_cash":385.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"3000204","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":335.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH LAB MATERNAL HGB LAB TEST","code_information":[{"code":"3000206","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83033","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEMOGLOBIN; GLYCOSYLATED","code_information":[{"code":"3000207","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":137.0,"discounted_cash":82.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"3000208","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PLASMA HEMOGLOBIN","code_information":[{"code":"3000209","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH LAB HOMOCYSTIEN LAB TEST","code_information":[{"code":"3000212","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC GLIADIN IGA LAB TEST","code_information":[{"code":"3000219","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":42.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MMUNOGLOBULIN BINDING PROTEIN","code_information":[{"code":"3000221","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":455.0,"discounted_cash":273.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  IMMUNOASSY QUANT, NOS LAB TEST","code_information":[{"code":"3000222","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":341.0,"discounted_cash":204.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH INSULIN LEVEL LAB TEST","code_information":[{"code":"3000223","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":222.0,"discounted_cash":133.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF INSULIN, FREE","code_information":[{"code":"3000224","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IRON","code_information":[{"code":"3000225","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":90.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":131.0,"discounted_cash":78.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IRON BINDING CAPACITY","code_information":[{"code":"3000226","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":154.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"3000228","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":288.0,"discounted_cash":172.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LACTATE DEHYDROGENASE (LDH)","code_information":[{"code":"3000229","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":105.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF LDH ENZYMES","code_information":[{"code":"3000230","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LACTOFERRIN,FECAL,QUAL","code_information":[{"code":"3000231","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LEAD, BLOOD","code_information":[{"code":"3000232","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.0,"discounted_cash":283.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":430.0,"discounted_cash":258.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LIPASE","code_information":[{"code":"3000235","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH LIPOPROTEIN (A) LAB TEST","code_information":[{"code":"3000236","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":143.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LIPOPROTEIN, HDL CHOLESTEROL","code_information":[{"code":"3000240","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LIPOPROTEIN, DIRECT MEASURE, LDL CHOLEST","code_information":[{"code":"3000241","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MAGNESIUM","code_information":[{"code":"3000243","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":289.0,"discounted_cash":173.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MASS SPECTROMETRY;QUANTITATIVE EA","code_information":[{"code":"3000245","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC SYNOVIAL FLUID MUCIN LAB TEST","code_information":[{"code":"3000252","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83872","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":298.0,"discounted_cash":178.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF MYOGLOBIN","code_information":[{"code":"3000254","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":259.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC NATRIURETIC PEPTIDE (BNP), NTPROBNP","code_information":[{"code":"3000255","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":439.0,"discounted_cash":263.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NUCLEOTIDASE 5- F5NUL","code_information":[{"code":"3000277","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSMOLALITY; BLOOD","code_information":[{"code":"3000283","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":209.0,"discounted_cash":125.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC OSMOLALITY; URINE","code_information":[{"code":"3000284","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PARATHORMONE","code_information":[{"code":"3000287","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":499.0,"discounted_cash":299.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PH,BODY FLUID,EXCEPT BLOOD","code_information":[{"code":"3000288","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CALPROTECTIN, FECAL","code_information":[{"code":"3000290","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHOSPHATASE,PROSTATIC PACP","code_information":[{"code":"3000293","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":186.0,"discounted_cash":111.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PHOSPHATASE, ALKALINE","code_information":[{"code":"3000294","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC REF LAB PG-AMNIOTIC AGGULT","code_information":[{"code":"3000296","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84081","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":418.0,"discounted_cash":250.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PHOSPHORUS","code_information":[{"code":"3000298","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINE PHOSPHORUS","code_information":[{"code":"3000299","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC POTASSIUM; SERUM","code_information":[{"code":"3000302","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE POTASSIUM","code_information":[{"code":"3000303","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PREALBUMIN","code_information":[{"code":"3000304","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":448.0,"discounted_cash":268.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PROGESTERONE","code_information":[{"code":"3000307","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PROLACIN","code_information":[{"code":"3000308","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":287.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":259.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LAB PSA TOTAL","code_information":[{"code":"3000311","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH PSA FREE LAB TEST","code_information":[{"code":"3000312","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PROTEIN, TOTAL","code_information":[{"code":"3000313","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PROTEIN-URINE","code_information":[{"code":"3000314","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PROTEIN, OTHER","code_information":[{"code":"3000315","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":209.0,"discounted_cash":125.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  PROTEIN ELECTRO LAB TEST","code_information":[{"code":"3000317","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":222.0,"discounted_cash":133.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC UR PROTEIN ELECTROPHORESIS LAB TEST","code_information":[{"code":"3000318","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST","code_information":[{"code":"3000320","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":418.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":637.0,"discounted_cash":382.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SODIUM; SERUM","code_information":[{"code":"3000333","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE SODIUM","code_information":[{"code":"3000334","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":136.0,"discounted_cash":81.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF SODIUM, OTHER SOURCE","code_information":[{"code":"3000335","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":136.0,"discounted_cash":81.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SPECTROPHOTOMETRY, ANALYTE NOS","code_information":[{"code":"3000337","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":299.0,"discounted_cash":179.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BODY FLUID SPECIFIC GRAVITY","code_information":[{"code":"3000338","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SUGARS (MONO,DI,OLIGO)SINGLE QUAL","code_information":[{"code":"3000340","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF TOTAL TESTOSTERONE","code_information":[{"code":"3000343","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":340.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":568.0,"discounted_cash":340.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO THIOCYANATE; FTIO","code_information":[{"code":"3000345","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84430","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":305.0,"discounted_cash":183.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF THYROGLOBULIN HTG2","code_information":[{"code":"3000346","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF TOTAL THYROXINE","code_information":[{"code":"3000347","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF FREE THYROXINE","code_information":[{"code":"3000348","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY THYROID STIM HORMONE","code_information":[{"code":"3000350","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRANSFERASE; ASPARTATE AMINO (AST/SGOT)","code_information":[{"code":"3000354","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRANSFERASE; ALANINE AMINO (ALT/SGPT)","code_information":[{"code":"3000355","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF TRANSFERRIN","code_information":[{"code":"3000356","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"3000357","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO THYROID UPTAKE; FRTUP","code_information":[{"code":"3000358","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":150.0,"discounted_cash":90.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRIIODOTHYRONINE T3; TOTAL (TT-3)","code_information":[{"code":"3000359","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRIIODOTHYRONINE T3; FREE","code_information":[{"code":"3000360","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":235.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":330.0,"discounted_cash":198.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TROPONIN, QUANTITATIVE","code_information":[{"code":"3000362","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":468.0,"discounted_cash":280.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF UREA NITROGEN","code_information":[{"code":"3000364","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE/UREA-N QUANT","code_information":[{"code":"3000365","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URIC ACID; BLOOD","code_information":[{"code":"3000366","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE/URC OTH SOURCE","code_information":[{"code":"3000367","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF VOLATILES","code_information":[{"code":"3000374","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":612.0,"discounted_cash":367.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC XYLOSE ABSORPTION TEST, BLOOD/URINE","code_information":[{"code":"3000375","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84620","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":265.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":405.0,"discounted_cash":243.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC C PEPTIDE LAB TEST","code_information":[{"code":"3000377","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GONADOTROPIN, CHORIONIC (HCG), QUANT","code_information":[{"code":"3000378","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GONADOTROPIN, CHORIONIC (HCG), QUAL","code_information":[{"code":"3000379","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED CHEMISTRY PROCEDURE","code_information":[{"code":"3000380","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":257.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BLOOD COUNT; MANUAL WBC DIFFERENTIAL","code_information":[{"code":"3000383","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":92.0,"discounted_cash":55.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD COUNT; HEMATOCRIT","code_information":[{"code":"3000385","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":92.0,"discounted_cash":55.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD COUNT; HEMOGLOBIN","code_information":[{"code":"3000386","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":92.0,"discounted_cash":55.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CBC - BLOOD COUNT; DIFFERENTIAL WBC","code_information":[{"code":"3000387","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD COUNT; HEMOGRAM & PLATELET COUNT","code_information":[{"code":"3000388","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":127.0,"discounted_cash":76.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD COUNT; RED BLOOD CELL (RBC) ONLY","code_information":[{"code":"3000389","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":92.0,"discounted_cash":55.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RETICULOCYTE COUNT, AUTOMATED","code_information":[{"code":"3000391","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":125.0,"discounted_cash":75.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD COUNT; LEUKOCYTE (WBC), AUTO","code_information":[{"code":"3000392","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":92.0,"discounted_cash":55.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PLATELET; AUTOMATED COUNT","code_information":[{"code":"3000393","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":149.0,"discounted_cash":89.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC LOW MOLE WT, ANTI-XA LAB TEST","code_information":[{"code":"3000394","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC F2 PROTHROMBIN, SPECIFIC LAB TEST","code_information":[{"code":"3000395","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":794.0,"discounted_cash":476.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR V (ACG/PROACCELERIN), LABILE FACT","code_information":[{"code":"3000396","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.0,"discounted_cash":505.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":769.0,"discounted_cash":461.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC F7 ASSAY LAB TEST","code_information":[{"code":"3000397","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":993.0,"discounted_cash":595.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":878.0,"discounted_cash":526.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH F8 ASSAY LAB TEST","code_information":[{"code":"3000398","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":300.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":439.0,"discounted_cash":263.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR VIII, VW FACTOR, RISTOCETIN COFAC","code_information":[{"code":"3000399","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":283.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":435.0,"discounted_cash":261.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH F8 VW AG LAB TEST","code_information":[{"code":"3000400","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR IX (PTC/CHRISTMAS)","code_information":[{"code":"3000402","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":288.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":439.0,"discounted_cash":263.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC F10 ASSAY LAB TEST","code_information":[{"code":"3000403","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":884.0,"discounted_cash":530.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC F11 ASSAY LAB TEST","code_information":[{"code":"3000404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":510.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":825.0,"discounted_cash":495.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC F12 ASSAY LAB TEST","code_information":[{"code":"3000405","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":610.0,"discounted_cash":366.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTITHROMBIN III, ACTIVITY","code_information":[{"code":"3000409","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":246.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":276.0,"discounted_cash":165.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  PROTEIN C ACTIVITY LAB TEST","code_information":[{"code":"3000412","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":276.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":446.0,"discounted_cash":267.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH PROTEIN S FREE LAB TEST","code_information":[{"code":"3000414","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":442.0,"discounted_cash":265.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ACTIVATED PROT C RESISTANCE LAB TEST","code_information":[{"code":"3000415","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":501.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":812.0,"discounted_cash":487.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC INHIBITOR ASSAY LAB TEST","code_information":[{"code":"3000416","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":843.0,"discounted_cash":505.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COAGULATION TIME;ACTIVATED","code_information":[{"code":"3000417","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":168.0,"discounted_cash":100.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC D-DIMER; QUANTITATIVE","code_information":[{"code":"3000421","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":318.0,"discounted_cash":190.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FIBRINOGEN; ACTIVITY","code_information":[{"code":"3000422","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":146.0,"discounted_cash":87.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HGB/RBC,FETAL,DIFF,KLEIHAUER-BETKE","code_information":[{"code":"3000426","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":318.0,"discounted_cash":190.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEMOGLOBIN/RBCS, FETAL; ROSETTE","code_information":[{"code":"3000427","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC  UNFRACTIONATED ANTI-XA LAB TEST","code_information":[{"code":"3000428","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":324.0,"discounted_cash":194.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PLATELET; AGGREGATION","code_information":[{"code":"3000433","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"3000435","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":77.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":104.0,"discounted_cash":62.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  DRVV LAB TEST","code_information":[{"code":"3000436","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SEDIMENTATION RATE, ERYTHROCYTE; AUTO","code_information":[{"code":"3000439","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":122.0,"discounted_cash":73.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RBC SICKLE CELL TEST","code_information":[{"code":"3000440","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC THROMBIN TIME; PLASMA","code_information":[{"code":"3000441","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC THROMBOPLASTIN TIME, PARTIAL (PTT)","code_information":[{"code":"3000442","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":117.0,"discounted_cash":70.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  PTT SUBSTITUTION LAB TEST","code_information":[{"code":"3000443","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ALLERGEN SPECIF IGE, INITIAL LAB TEST","code_information":[{"code":"3000448","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH HEPARIN DEP AB LAB TEST","code_information":[{"code":"3000450","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":972.0,"discounted_cash":583.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ANA W/REFLEX LAB TEST","code_information":[{"code":"3000452","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTINUCLEAR ANTIBODIES; TITER","code_information":[{"code":"3000453","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":210.0,"discounted_cash":126.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC C-RE1 PROTEIN","code_information":[{"code":"3000457","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":177.0,"discounted_cash":106.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC C-RE1 PROTEIN; HIGH SENS","code_information":[{"code":"3000458","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC CARDIOLIPIN ANTIBODY IGG","code_information":[{"code":"3000460","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":199.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":333.0,"discounted_cash":199.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIPHOSPHATYDLSERINE, ASL LAB, ALABS","code_information":[{"code":"3000461","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":119.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COLD AGGLUTININ, TITER","code_information":[{"code":"3000462","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH COMPLEMENT COMPONENET LAB TEST","code_information":[{"code":"3000463","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COMPLEMENT; FUNCTIONAL ACTIVITY","code_information":[{"code":"3000464","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":600.0,"discounted_cash":360.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH CCP AB LAB TEST","code_information":[{"code":"3000467","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":43.0,"discounted_cash":25.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC NATIVE OR DBL STRAND DNA AB LAB TEST","code_information":[{"code":"3000469","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":566.0,"discounted_cash":339.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ENA INITIAL LAB TEST","code_information":[{"code":"3000471","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH FLUORESCENT AB, SCREEN LAB TEST","code_information":[{"code":"3000472","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":109.0,"discounted_cash":65.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  FLUORESCENT AB, TITER LAB TEST","code_information":[{"code":"3000473","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":409.0,"discounted_cash":245.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, TUMOR CA 15-3","code_information":[{"code":"3000475","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, TUMOR CA 125","code_information":[{"code":"3000477","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":231.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":352.0,"discounted_cash":211.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HETEROPHILE ANTIBODIES; SCREEN","code_information":[{"code":"3000478","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, INF AGENT AB NOS","code_information":[{"code":"3000480","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH IMMUNOFIXATION LAB TEST","code_information":[{"code":"3000484","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":261.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":402.0,"discounted_cash":241.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  IMMUNOFIX ELECTROPH, FLD LAB TEST","code_information":[{"code":"3000485","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":261.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ISLET CELL ANTIBODY(SO)","code_information":[{"code":"3000489","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC B CELLS TOTAL COUNT LAB TEST","code_information":[{"code":"3000491","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":283.0,"discounted_cash":169.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  MONONUCL CELL AG QT LAB TEST","code_information":[{"code":"3000492","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":344.0,"discounted_cash":206.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH NATURAL KILLER CELLS TOT LAB TEST","code_information":[{"code":"3000493","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":284.0,"discounted_cash":170.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH T CELLS TOTAL LAB TEST","code_information":[{"code":"3000494","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":338.0,"discounted_cash":202.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  CD4&CD8 CNT W/ RATIO LAB TEST","code_information":[{"code":"3000495","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":563.0,"discounted_cash":337.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH ANTI THYROID PEROXID AB LAB TEST","code_information":[{"code":"3000497","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC CYRPT AG, QUAL, SERUM LAB TEST","code_information":[{"code":"3000500","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYPRO AG, QUANT, SERUM LAB TEST","code_information":[{"code":"3000501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86406","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":260.0,"discounted_cash":156.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RHEUMATOID FACTOR; QUALITATIVE","code_information":[{"code":"3000502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RHEUMATOID FACTOR; QUANT","code_information":[{"code":"3000503","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":147.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH TB CELL MED  AG RESP LAB TEST","code_information":[{"code":"3000504","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":294.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":478.0,"discounted_cash":286.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC SYPHILIS TEST; QUAL LAB TEST","code_information":[{"code":"3000505","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC SYPHILIS TEST; QUANTITATIVE LAB TEST","code_information":[{"code":"3000506","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":119.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH ASPERGILLUS AB LAB TEST","code_information":[{"code":"3000508","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MICROPOLYSPORA FAENI IGG ANTI; MPSF","code_information":[{"code":"3000509","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":448.0,"discounted_cash":268.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH BLASTOMYCES AB LAB TEST","code_information":[{"code":"3000511","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY, BORDETELLA","code_information":[{"code":"3000512","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":253.0,"discounted_cash":151.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  B. BURGDORFERI, LYME AB LAB TEST","code_information":[{"code":"3000514","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":276.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":446.0,"discounted_cash":267.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH COCCIDIOIDES AB LAB TEST","code_information":[{"code":"3000520","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH CYTOMEGALOVIRUS AB LAB TEST","code_information":[{"code":"3000523","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":316.0,"discounted_cash":189.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH CYTOMEGALOVIRUS AB, IGM LAB TEST","code_information":[{"code":"3000524","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; DIPHTHERIA DIPGS","code_information":[{"code":"3000525","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86648","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC AB; EBV EARLY ANTIGEN LAB TEST","code_information":[{"code":"3000531","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC EBV AB NUCLEAR ANTIGEN LAB TEST","code_information":[{"code":"3000532","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":143.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":230.0,"discounted_cash":138.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC EBV AB VIRAL CAPSID IGM LAB TEST","code_information":[{"code":"3000533","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC H. PYLORI IGG AB LAB TEST","code_information":[{"code":"3000538","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":288.0,"discounted_cash":172.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY HTLV/HIV ANTIBODY CONFIRM HV1WB","code_information":[{"code":"3000541","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":236.0,"discounted_cash":141.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HEPATITIS, DELTA AGENT","code_information":[{"code":"3000542","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"discounted_cash":371.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":566.0,"discounted_cash":339.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HERPES SIMPLEX IAB GM LAB TEST","code_information":[{"code":"3000543","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HERPES SIMPLEX, TYPE 1","code_information":[{"code":"3000544","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HERPES SIMPLEX, TYPE 2","code_information":[{"code":"3000545","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH HISTO CAP H, AB LAB TEST","code_information":[{"code":"3000546","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HIV-1","code_information":[{"code":"3000547","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEPATITIS B CORE, IGM","code_information":[{"code":"3000550","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HEP B SURF AB LAB TEST","code_information":[{"code":"3000551","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEPATITIS A ANTIBODY; IGM","code_information":[{"code":"3000554","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; LEPTOSPIRA","code_information":[{"code":"3000557","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MUMPS AB","code_information":[{"code":"3000559","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH MYCOPLASMA INITIAL LAB TEST","code_information":[{"code":"3000560","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH RUBELLA AB 1ST LAB TEST","code_information":[{"code":"3000567","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH RUBEOLA (MEASLES) AB LAB TEST","code_information":[{"code":"3000568","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":316.0,"discounted_cash":189.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; TETANUS TTIGS","code_information":[{"code":"3000570","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":68.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":109.0,"discounted_cash":65.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH AB TOXOPLASMA, IGG LAB TEST","code_information":[{"code":"3000571","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH TOXOPLASMA AB IGM LAB TEST","code_information":[{"code":"3000572","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":151.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":244.0,"discounted_cash":146.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH VARICELLA-ZOSTER AB, IGG LAB TEST","code_information":[{"code":"3000575","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":316.0,"discounted_cash":189.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH THROGLOBULIN AB LAB TEST","code_information":[{"code":"3000579","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":151.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HEP C AB LAB TEST","code_information":[{"code":"3000580","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":481.0,"discounted_cash":288.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH HLA A,B OR C SINGLE AG LAB TEST","code_information":[{"code":"3000582","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY SCREEN, EACH SERUM TECHNIQUE","code_information":[{"code":"3000585","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY ELUTION","code_information":[{"code":"3000586","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":179.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":288.0,"discounted_cash":172.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY ID, RBC, EACH PANEL","code_information":[{"code":"3000587","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":245.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":475.0,"discounted_cash":285.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; DIRECT","code_information":[{"code":"3000588","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":206.0,"discounted_cash":123.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; INDIRECT","code_information":[{"code":"3000589","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; INDIRECT, TITER","code_information":[{"code":"3000590","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD TYPING; ABO","code_information":[{"code":"3000592","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":149.0,"discounted_cash":89.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD TYPING; RH (D)","code_information":[{"code":"3000593","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":91.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":73.0,"discounted_cash":43.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RBC ANTIGEN TYPING, OTHER THAN ABO/RH(D)","code_information":[{"code":"3000595","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COMPATIBILITY TEST; IMMED SPIN, ADD UNIT","code_information":[{"code":"3000597","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":192.0,"discounted_cash":115.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COMPATIBILITY TEST, EA UNIT; INCUBATION","code_information":[{"code":"3000598","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86921","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COMPATIBILITY TEST, EA UNIT; AHG","code_information":[{"code":"3000599","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":257.0,"discounted_cash":154.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COMPATIBILITY TEST EA UNIT; ELECTRONIC","code_information":[{"code":"3000600","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":372.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":478.0,"discounted_cash":286.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RBC PRETREAT, AB ID, INCUBATE CHEM/DRUG","code_information":[{"code":"3000605","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC RBC PRETREAT,ANTIBODY ID,W/ENZYMES EA","code_information":[{"code":"3000606","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRETREATMENT OF RBC BY DEN GRP SEP","code_information":[{"code":"3000607","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SERUM PRETREAT, AB ID, INCUBATE W/ INHIB","code_information":[{"code":"3000609","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86977","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SERUM PRETREAT, AB ID, DIFF RBC ABSORPT","code_information":[{"code":"3000610","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":283.0,"discounted_cash":169.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CONCENTRATION, FOR INFECTIOUS AGENTS","code_information":[{"code":"3000611","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":81.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CULTURE; BLOOD (W/ ANAEROBIC SCREEN)","code_information":[{"code":"3000612","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":414.0,"discounted_cash":248.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE; STOOL","code_information":[{"code":"3000613","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":198.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":194.0,"discounted_cash":116.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE; STOOL, ADDL PATHOGENS","code_information":[{"code":"3000614","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":40.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, BACTERIA, OTHER","code_information":[{"code":"3000615","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, BACTERIA; QUANTITATIVE, AEROBIC","code_information":[{"code":"3000616","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, BACTERIA; QUANT, ANAEROBIC","code_information":[{"code":"3000617","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87073","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, ANAEROBIC","code_information":[{"code":"3000618","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANAEROBIC ISOLATE, DEFINITIVE ID, EA","code_information":[{"code":"3000619","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":133.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC AEROBIC ISOLATE, DEFINITIVE ID, EACH","code_information":[{"code":"3000620","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":124.0,"discounted_cash":74.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, SCREENING ONLY","code_information":[{"code":"3000621","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":115.0,"discounted_cash":69.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE; QUANT COLONY COUNT, URINE","code_information":[{"code":"3000622","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULT, W/ISOL & EA PRESUMP ID, UR","code_information":[{"code":"3000623","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, FUNGI, SKIN/HAIR/NAIL","code_information":[{"code":"3000624","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":313.0,"discounted_cash":187.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, FUNGI, OTHER, EXCEPT BLOOD","code_information":[{"code":"3000625","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, FUNGI, BLOOD","code_information":[{"code":"3000626","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":308.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC FUNGUS YEAST IDENT LAB TEST","code_information":[{"code":"3000627","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, DEFINITIVE ID, MOLD","code_information":[{"code":"3000628","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, MYCOBACTERIA","code_information":[{"code":"3000631","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":417.0,"discounted_cash":250.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE TYPING;IMMUNOFL METHOD, EA","code_information":[{"code":"3000632","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE TYPING; IMMUNOLOGIC METHOD","code_information":[{"code":"3000634","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE TYPING;ID BY NUCL ACID PROBE","code_information":[{"code":"3000635","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":328.0,"discounted_cash":196.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MACROSCOPIC EXAM; ARTHROPOD","code_information":[{"code":"3000637","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":179.0,"discounted_cash":107.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MACROSCOPIC EXAM; PARASITE","code_information":[{"code":"3000638","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PINWORM EXAM","code_information":[{"code":"3000639","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HOMOGENIZATION, TISSUE, FOR CULTURE","code_information":[{"code":"3000640","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":81.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":122.0,"discounted_cash":73.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC OVA & PARASITES, DIRECT SMEAR, CONC & ID","code_information":[{"code":"3000641","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SUSCEPTABILITY STUDIES, AGAR DILUTION","code_information":[{"code":"3000642","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":48.0,"discounted_cash":28.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SUSCEPTIBILITY STUDIES, DISK METHOD","code_information":[{"code":"3000643","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":114.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SUSCEPTIBILITY STUDIES, ENZYME DETECTION","code_information":[{"code":"3000644","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SUSCEPTIBILITY STUDIES, MICRODILUTION","code_information":[{"code":"3000645","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":139.0,"discounted_cash":83.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SMEAR, GRAM / GIEMSA STAIN","code_information":[{"code":"3000647","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":151.0,"discounted_cash":90.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SMEAR, MODIFIED ACID FAST","code_information":[{"code":"3000648","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SMEAR, INCLUSION BODIES, PARASITES","code_information":[{"code":"3000649","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":212.0,"discounted_cash":127.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SMEAR, COMPLEX SP STAIN, OVA & PARASITES","code_information":[{"code":"3000650","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":133.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SMEAR, WET MOUNT","code_information":[{"code":"3000651","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC KOH TISSUE EXAMINATION","code_information":[{"code":"3000652","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH VIRAL OBS, PRESUMP ID LAB TEST","code_information":[{"code":"3000654","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":514.0,"discounted_cash":308.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC VIRUS TISSUE CULTURE, ADD/DEFIN ID","code_information":[{"code":"3000655","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":328.0,"discounted_cash":196.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH VIR SHELL  W/ IMM ID, EA LAB TEST","code_information":[{"code":"3000656","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":329.0,"discounted_cash":197.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC VIRUS ISOLATION; ID BY NON-IMMUNO METHOD","code_information":[{"code":"3000657","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":370.0,"discounted_cash":222.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC LAB LEGION PNEUMO, AG LAB TEST","code_information":[{"code":"3000662","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87278","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":417.0,"discounted_cash":250.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AG DETECT ENZYME IMMUNO ASPERGILLUS, ASPBA","code_information":[{"code":"3000666","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":280.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHLAMYDIA TRACHOMATIS, ANTIGEN, EIA","code_information":[{"code":"3000667","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87320","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":256.0,"discounted_cash":153.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS","code_information":[{"code":"3000668","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":316.0,"discounted_cash":189.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CRYTOSPORIDUM/GIARDIA, AG EIA","code_information":[{"code":"3000670","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":194.0,"discounted_cash":116.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GIARDIA AG, EIA","code_information":[{"code":"3000671","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HEP B SURF AG LAB TEST","code_information":[{"code":"3000675","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":195.0,"discounted_cash":117.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN NEUTRAL","code_information":[{"code":"3000676","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":195.0,"discounted_cash":117.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HISTOPLASMA CAPSULATUM FMVHU","code_information":[{"code":"3000679","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":540.0,"discounted_cash":324.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ROTAVIRUS, ANTIGEN, EIA","code_information":[{"code":"3000681","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":357.0,"discounted_cash":214.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SHIGA-LIKE TOXIN, CAMPY AG, EIA","code_information":[{"code":"3000682","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INF ANTIGEN NOS, MULT STEP, EIA","code_information":[{"code":"3000684","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":266.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":406.0,"discounted_cash":243.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC C PHEUMONIAE, AMP PROBE LAB TEST","code_information":[{"code":"3000688","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":388.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":630.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH C TRACHOMATIS, AMP PROBE LAB TEST","code_information":[{"code":"3000690","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CYTOMEGALOVIRUS MOLECULAR DETECT PCR LCMV","code_information":[{"code":"3000691","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":433.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":699.0,"discounted_cash":419.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ENTEROVIRUS,AMPL PROBE TECHNIQUE","code_information":[{"code":"3000693","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.0,"discounted_cash":307.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":562.0,"discounted_cash":337.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH HEP C QUANT RNA PCR LAB TEST","code_information":[{"code":"3000696","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":582.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":941.0,"discounted_cash":564.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH HIV 1 QUANT RNA LAB TEST","code_information":[{"code":"3000699","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":586.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":894.0,"discounted_cash":536.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MYCOBACTERIA TB,AMPLIFD PROBE TECH MTBRP","code_information":[{"code":"3000700","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":593.0,"discounted_cash":355.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC  M PNEUMONIA, AMP PROBE LAB TEST","code_information":[{"code":"3000701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":383.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":620.0,"discounted_cash":372.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  N GONOR, AMP PRB LAB TEST","code_information":[{"code":"3000703","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":198.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":284.0,"discounted_cash":170.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC MRSA AMP PROBE LAB TEST","code_information":[{"code":"3000705","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":417.0,"discounted_cash":250.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC INF AGT DET AMPL PROBE ADL LAB TEST","code_information":[{"code":"3000706","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":591.0,"discounted_cash":354.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INFECT AGENT, MULTI, AMPL PROBE(S) BARTB","code_information":[{"code":"3000709","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":299.0,"discounted_cash":179.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 87804 INFLUENZA A ANTIGEN","code_information":[{"code":"3000710","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INF AGENT AG IM ASSAY DIR OBSV,RSV","code_information":[{"code":"3000711","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":343.0,"discounted_cash":205.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INF AG W/OPTIC STREP GRP A","code_information":[{"code":"3000712","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":114.0,"discounted_cash":68.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INFECTIOUS AGENT NOS, DIRECT OBS","code_information":[{"code":"3000713","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HEPATITIS C VIRUS HCVG","code_information":[{"code":"3000716","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.0,"discounted_cash":894.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1405.0,"discounted_cash":843.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC LAB  FLOW CYTOMETRY 1ST SURF MARKER","code_information":[{"code":"3000719","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":375.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMOSOMAL IN SITU HYBRID 3-5","code_information":[{"code":"3000727","type":"CDM"},{"code":"0300","type":"RC"},{"code":"88272","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":514.0,"discounted_cash":308.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CELL COUNT, EXCEPT BLOOD-BODY FLD","code_information":[{"code":"3000733","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":331.0,"discounted_cash":198.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CELL COUNT, W/DIFFERENTIAL COUNT-FLUID","code_information":[{"code":"3000734","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":331.0,"discounted_cash":198.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLUID, CRYSTALS (BODY)","code_information":[{"code":"3000735","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":244.0,"discounted_cash":146.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC NASAL SMEAR, EOSINOPHILS","code_information":[{"code":"3000738","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":103.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":163.0,"discounted_cash":97.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRAVEL ALLOWANCE-1","code_information":[{"code":"3000742","type":"CDM"},{"code":"0300","type":"RC"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RHODIMMUNE GLOBULIN, HUMAN 300 MCG","code_information":[{"code":"3000743","type":"CDM"},{"code":"0636","type":"RC"},{"code":"90384","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PHLEBOTOMY, THERAPEUTIC LAB","code_information":[{"code":"3000744","type":"CDM"},{"code":"0940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PSA, SCREENING","code_information":[{"code":"3000747","type":"CDM"},{"code":"0300","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":253.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GLUCOSE,QT BY METER FOR","code_information":[{"code":"3000748","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":84.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CANDIDA SPECIES,DIRECT PROBE TECHNIQUE","code_information":[{"code":"3000749","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87480","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":76.0,"discounted_cash":45.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GARDNERELLA VAGINALIS,DIR PROBE TECHNIQUE","code_information":[{"code":"3000750","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87510","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":76.0,"discounted_cash":45.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRICHOMONAS VAGINALIS,DIR PROBE TECHNIQUE","code_information":[{"code":"3000751","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87660","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":76.0,"discounted_cash":45.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC STAPH AUREUS, AMPLIFIED PROBE TECH","code_information":[{"code":"3000756","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC PROCALCITONIN LAB TEST","code_information":[{"code":"3000757","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":437.0,"discounted_cash":262.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CELLULAR FUNCTION STIM W/BIOMARKER DET; FCUIX","code_information":[{"code":"3000760","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":481.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":755.0,"discounted_cash":453.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH TREPONEMA PALLIDIUM AB LAB TEST","code_information":[{"code":"3000761","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":152.0,"discounted_cash":91.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE TYPING;ID BY AMP PROBE EA","code_information":[{"code":"3000764","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":496.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":757.0,"discounted_cash":454.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC C.DIFF TOXIN GENE(S) AMP PROBE","code_information":[{"code":"3000766","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":277.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":422.0,"discounted_cash":253.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PED PROF 17-HYDROXY PREGNENOLONE","code_information":[{"code":"3000772","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":284.0,"discounted_cash":170.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC THIN PREP PAP AUTO SCN MANUAL RESCN","code_information":[{"code":"3000782","type":"CDM"},{"code":"0311","type":"RC"},{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD TYPING; AG TEST OF DONOR BLD EA TST","code_information":[{"code":"3000789","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HERPES VIR 6, AMPLIFIED PROBE HHV6","code_information":[{"code":"3000805","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87532","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":515.0,"discounted_cash":309.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC LAMELLAR BODY DENSITY LAB TEST","code_information":[{"code":"3000819","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83664","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":182.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  HIV 1&2 SINGLE RESULT LAB TEST","code_information":[{"code":"3000820","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":364.0,"discounted_cash":218.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  QUANTITATIVE ASSAY, DRUG","code_information":[{"code":"3000830","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":248.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  AMYLASE","code_information":[{"code":"3000832","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  CHOLESTEROL, SERUM, TOTAL","code_information":[{"code":"3000833","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC GAMMAGLOBULIN, IGA, IGD, IGG, IGM, EA","code_information":[{"code":"3000835","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":193.0,"discounted_cash":115.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC IGA, IGD, IGG, IGM,EA ADL LAB TEST","code_information":[{"code":"3000836","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  IGG SUBCLASSES","code_information":[{"code":"3000837","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":158.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":242.0,"discounted_cash":145.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  CULTURE, BACTERIA, OTHER","code_information":[{"code":"3000838","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GTT EACH ADDITIONAL SEPCIMEN BEYOND 3 SPECIMENS","code_information":[{"code":"3000839","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":118.0,"discounted_cash":70.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC GLIADIN IGG LAB TEST","code_information":[{"code":"3000840","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  IMMUNOASSAY,OTH QL,SEMQT,MLTISIP","code_information":[{"code":"3000841","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":42.0,"discounted_cash":25.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  IMMUNOGLOBULIN BINDING PROTEIN","code_information":[{"code":"3000842","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":326.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":455.0,"discounted_cash":273.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GANGLIOSIDE ANTI PANEL; GM1B","code_information":[{"code":"3000843","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":217.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":341.0,"discounted_cash":204.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3000844","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":478.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":727.0,"discounted_cash":436.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3000845","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.0,"discounted_cash":701.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":1072.0,"discounted_cash":643.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  NEPHELOMETRY ASSAY,NOS","code_information":[{"code":"3000846","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":242.0,"discounted_cash":145.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC/DMH LAMBDA LIGHT CHAIN LAB TEST","code_information":[{"code":"3000847","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  OLIGOCLONAL BANDS","code_information":[{"code":"3000879","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":222.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":337.0,"discounted_cash":202.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ASSY OF TESTOSTERONE FREE ADDTL BATS/TTFB","code_information":[{"code":"3000880","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  TRIGLYCERIDES","code_information":[{"code":"3000881","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SFMC ALLERGEN SPECIFIC  IGE ADL LAB TEST","code_information":[{"code":"3000884","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO BETA 2 GLYCOPROTEIN ANTIBODY EA ADDTL B2GLY","code_information":[{"code":"3000885","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":238.0,"discounted_cash":142.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC CARDIOLIPIN ANTIBODY EACH IGM","code_information":[{"code":"3000886","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":199.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":333.0,"discounted_cash":199.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC CARDIOLIPIN ANTIBODY IGA","code_information":[{"code":"3000887","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":199.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":333.0,"discounted_cash":199.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTIPHOSPHATYDLSERINE, ASL LAB, ALABS","code_information":[{"code":"3000888","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":344.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":119.0,"discounted_cash":71.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC/DMH ENA ADDTL LAB TEST","code_information":[{"code":"3000889","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC ENA AB ADL LAB TEST","code_information":[{"code":"3000890","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  FLUORESCENT ANTIBODY, TITER","code_information":[{"code":"3000891","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  IMMUNOASSAY, INF AGENT AB NOS","code_information":[{"code":"3000892","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO STREPTOCOCCUS PHEUMONIAE IGG ANTO 23; PN23","code_information":[{"code":"3000893","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":25.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":41.0,"discounted_cash":24.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI BARTONELLA B.QUINTANA IGG BART","code_information":[{"code":"3000894","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":103.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO BORDETELLA PERTUSSIS AB IGA IGG FBAGI","code_information":[{"code":"3000895","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":165.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":253.0,"discounted_cash":151.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO LYME DISEASE IGM AB LYWB LAB TEST","code_information":[{"code":"3000896","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":283.0,"discounted_cash":169.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CHLAMYDIA C.PNEUMONIAE IGG SCLAM","code_information":[{"code":"3000897","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO CHLAMYDIA C.PNEUMONIAE IGM SCLAM","code_information":[{"code":"3000898","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":105.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ANTIBODY, COXIELLA BRUNETTI IGG ADDL, QFP","code_information":[{"code":"3000899","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  ANTIBODY; ENCEPH, CALIFORNIA","code_information":[{"code":"3000900","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; ENCEPHALITIS, EASTERN","code_information":[{"code":"3000902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  CREATININE, OTHER SOURCE","code_information":[{"code":"3000904","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":87.0,"discounted_cash":52.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ANTIBODY; ENCEPHALITIS, ST. LOUIS","code_information":[{"code":"3000905","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; ENCEPHALITIS, WESTERN","code_information":[{"code":"3000907","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY, ENTEROVIRUS","code_information":[{"code":"3000909","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; EBV, VIRAL CAPSID","code_information":[{"code":"3000910","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":270.0,"discounted_cash":162.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  FUNGUS,NOT ELSEWHERE SPECIFIED","code_information":[{"code":"3000911","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":206.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; HTLV/HIV ANTIBODY, CONFIRM","code_information":[{"code":"3000913","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":442.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":676.0,"discounted_cash":405.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; HERPES SIMPLEX, TYPE 1","code_information":[{"code":"3000914","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; HERPES SIMPLEX, TYPE 2","code_information":[{"code":"3000915","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ANTIBODY; HISTOPLASMA. SHTO","code_information":[{"code":"3000916","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC/DMH HISTO CAP M, AB LAB TEST","code_information":[{"code":"3000917","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO INFULENZA VIRUS A SERUM IGM/SFLA","code_information":[{"code":"3000918","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; INFLUENZA VIRUS","code_information":[{"code":"3000920","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC ALBUMNIN OTHER SOURCE NON URINE","code_information":[{"code":"3000921","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":136.0,"discounted_cash":81.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  MICROALBUMIN, QUANTITATIVE","code_information":[{"code":"3000922","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":73.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":122.0,"discounted_cash":73.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  IONIZED CALCIUM","code_information":[{"code":"3000923","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":299.0,"discounted_cash":179.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ASSAY OF CALCIUM IN URINE","code_information":[{"code":"3000924","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CREATINE KINASE (CPK); TOTAL","code_information":[{"code":"3000925","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC IGE LAB TEST","code_information":[{"code":"3000926","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":308.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  GASES, BLOOD, ARTERIAL W/ DIRECT O2 SAT","code_information":[{"code":"3000927","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":361.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":552.0,"discounted_cash":331.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"3000928","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC MMUNO MLTISIP INITIAL LAB TEST","code_information":[{"code":"3000929","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ASSAY OF LACTIC ACID","code_information":[{"code":"3000930","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":288.0,"discounted_cash":172.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  LACTATE DEHYDROGENASE (LDH)","code_information":[{"code":"3000931","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":105.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":157.0,"discounted_cash":94.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC MAGNESIUM IONIZED LAB TEST","code_information":[{"code":"3000932","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":179.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":289.0,"discounted_cash":173.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC NEPHELOMETRY ASSAY,NOS. ASO LAB TEST","code_information":[{"code":"3000933","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":162.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH KAPPA LIGHT CHAIN LAB TEST","code_information":[{"code":"3000934","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  PARATHORMONE","code_information":[{"code":"3000935","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":499.0,"discounted_cash":299.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ASSAY OF PROTEIN-URINE","code_information":[{"code":"3000936","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ASSAY OF URINE/UREA-N QUANT","code_information":[{"code":"3000937","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  PROTHROMBIN TIME","code_information":[{"code":"3000938","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":104.0,"discounted_cash":62.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  PROTHROMBIN TIME","code_information":[{"code":"3000939","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":146.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":104.0,"discounted_cash":62.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COMPLEMENT; C1Q","code_information":[{"code":"3000940","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ENA INITIAL LAB TEST","code_information":[{"code":"3000941","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":228.0,"discounted_cash":136.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  NUCLEAR ANTIGEN  ANTIBODY","code_information":[{"code":"3000942","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":343.0,"discounted_cash":205.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH FLUORESCENT AB, TITER LAB TEST","code_information":[{"code":"3000943","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":114.0,"discounted_cash":68.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ANTI SMOOTH MUSCLE AB LAB TEST","code_information":[{"code":"3000944","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":409.0,"discounted_cash":245.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC SYPHILIS VDRL CSF LAB TEST","code_information":[{"code":"3000945","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ANTIBODY; CYTOMEGALOVIRUS","code_information":[{"code":"3000946","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":241.0,"discounted_cash":144.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ANTIBODY; CYTOMEGALOVIRUS, IGM","code_information":[{"code":"3000947","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC EBV AB VIRAL CAPSID IGG LAB TEST","code_information":[{"code":"3000948","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":270.0,"discounted_cash":162.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC REF ANTIBODY; HERPES SIMPLEX, TYPE 1","code_information":[{"code":"3000949","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HERPES SIMPLEX TYPE 2 AB LAB TEST","code_information":[{"code":"3000950","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HISTOPLASMA AB LAB TEST","code_information":[{"code":"3000951","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":103.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ANTIHUMAN GLOBULIN; INDIRECT","code_information":[{"code":"3000952","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  BLOOD TYPING; ABO","code_information":[{"code":"3000953","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":156.0,"discounted_cash":93.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  BLOOD TYPING; ABO","code_information":[{"code":"3000954","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":156.0,"discounted_cash":93.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  RBC ANTIGEN TYPING, OTHER THAN ABO/RH(D)","code_information":[{"code":"3000955","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  CULTURE; STOOL, ADDL PATHOGENS","code_information":[{"code":"3000958","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":151.0,"discounted_cash":90.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CULTURE, BACTERIA, OTHER","code_information":[{"code":"3000959","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":364.0,"discounted_cash":218.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  AEROBIC ISOLATE, DEFINITIVE ID, EACH","code_information":[{"code":"3000960","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":124.0,"discounted_cash":74.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CULTURE, SCREENING ONLY","code_information":[{"code":"3000961","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":123.0,"discounted_cash":73.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CULTURE, FUNGI, OTHER, EXCEPT BLOOD","code_information":[{"code":"3000962","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CULTURE, DEFINITIVE ID, YEAST","code_information":[{"code":"3000963","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CULTURE TYPING; IMMUNOLOGIC METHOD","code_information":[{"code":"3000964","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CULTURE TYPING; IMMUNOLOGIC METHOD","code_information":[{"code":"3000965","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  SUSCEPTIBILITY STUDIES, DISK METHOD","code_information":[{"code":"3000967","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":114.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":76.0,"discounted_cash":45.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  SMEAR, GRAM / GIEMSA STAIN","code_information":[{"code":"3000969","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":151.0,"discounted_cash":90.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  SMEAR, WET MOUNT","code_information":[{"code":"3000970","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.0,"discounted_cash":119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  VIRUS ISOLATION; SHELL VIAL W/ IMMUNO ID","code_information":[{"code":"3000971","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":329.0,"discounted_cash":197.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  CELL COUNT, EXCEPT BLOOD-BODY FLD","code_information":[{"code":"3000972","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":331.0,"discounted_cash":198.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  ANTIBODY;LYMPHOCYT CHORIOMENINGITIS","code_information":[{"code":"3000973","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ANTIBODY; MUMPS, FMCPL ADTL CSF","code_information":[{"code":"3000974","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SFMC/DMH MYCOPLASMA ADL LAB TEST","code_information":[{"code":"3000975","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PARVOVIRUS B19 MOLECULAR DETECT; PARV","code_information":[{"code":"3000976","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO BABESIA MICROTI ANTI IGM FBAB","code_information":[{"code":"3000977","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO RICKETTSIA IGM AB SFGP","code_information":[{"code":"3000978","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":245.0,"discounted_cash":147.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC RUBELLA AB ADL LAB TEST","code_information":[{"code":"3000979","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":175.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":284.0,"discounted_cash":170.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  ANTIBODY; RUBEOLA","code_information":[{"code":"3000980","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  CULTURE; STOOL, ADDL PATHOGENS","code_information":[{"code":"3000981","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":151.0,"discounted_cash":90.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  CULTURE TYPING;IMMUNOFL METHOD, EA","code_information":[{"code":"3000982","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  SUSCEPTABILITY STUDIES, AGAR DILUTION","code_information":[{"code":"3000983","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":81.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":48.0,"discounted_cash":28.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  HERPES SIMPLEX VIRUS,AMPLIFIED PROBE","code_information":[{"code":"3000984","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":680.0,"discounted_cash":408.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SFMC INF AGT DET AMP PRB INIT LAB TEST","code_information":[{"code":"3000985","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":366.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":591.0,"discounted_cash":354.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 87804 INFLUENZA B ANTIGEN","code_information":[{"code":"3000986","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":163.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC FLOW CYTOMETRY 1ST SURF MARKER","code_information":[{"code":"3000987","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":247.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":378.0,"discounted_cash":226.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC BASIC METABOLIC PANEL W IONIZED CALCIUM","code_information":[{"code":"3000990","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80047","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":382.0,"discounted_cash":229.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY, CARBAMAZEPINE, TOTAL","code_information":[{"code":"3000994","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF ETHOSUXIMIDE","code_information":[{"code":"3000996","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":187.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF LIDOCAINE","code_information":[{"code":"3000997","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":179.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PHENOBARBITAL","code_information":[{"code":"3000999","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PHENYTOIN, FREE","code_information":[{"code":"3001000","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PRIMIDONE","code_information":[{"code":"3001001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":221.0,"discounted_cash":132.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF TOPIRAMATE; TOPI","code_information":[{"code":"3001002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":261.0,"discounted_cash":156.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO LEFLUNOMIDE METABOLITE (TERIFLUNOMIDE) LEFLU","code_information":[{"code":"3001003","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":657.0,"discounted_cash":394.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ACYLCARNITINES QUANT PLASMA ACRN","code_information":[{"code":"3001004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82017","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":445.0,"discounted_cash":267.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY, ADRENOCORTICOTROPIC HORMONE; ACTH","code_information":[{"code":"3001005","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":321.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":505.0,"discounted_cash":303.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF ALDOLASE; ALS","code_information":[{"code":"3001007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":168.0,"discounted_cash":100.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF ALDOSTERONE; ALDU","code_information":[{"code":"3001008","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":488.0,"discounted_cash":292.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ALPHA-1-ANTITRYPSIN,TOTAL A1AF","code_information":[{"code":"3001009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ALPHA-1 ANTITRYPSIN; PHENOTYPE","code_information":[{"code":"3001010","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":198.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":335.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ALPHA-FETOPROTEIN, SERUM; AFPA","code_information":[{"code":"3001012","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82106","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ALUMINUM; AL","code_information":[{"code":"3001013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":259.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC AMINO ACIDS, MULT QUALITATIVE SCREEN","code_information":[{"code":"3001014","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82128","type":"HCPCS"}],"standard_charges":[{"gross_charge":1054.0,"discounted_cash":632.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":966.0,"discounted_cash":579.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC AMINO ACIDS, SINGLE QUANT","code_information":[{"code":"3001015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":858.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1307.0,"discounted_cash":784.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AMINO ACIDS,2-5 QUANT,EA; CYSQN","code_information":[{"code":"3001016","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82136","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":388.0,"discounted_cash":232.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AMINO ACIDS QUANT PLASMA AAQP","code_information":[{"code":"3001017","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":427.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANDROSTENEDIONE; ANST","code_information":[{"code":"3001018","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":361.0,"discounted_cash":216.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST","code_information":[{"code":"3001019","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":265.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":405.0,"discounted_cash":243.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANGIOTENSIN CNVRTG ENZYM ACE","code_information":[{"code":"3001020","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":242.0,"discounted_cash":145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO APOLIPOPRTEIN A1 PLASMA APLA1","code_information":[{"code":"3001021","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":177.0,"discounted_cash":106.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ARSENIC BLOOD ASB","code_information":[{"code":"3001022","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF ARSENIC ASFRU","code_information":[{"code":"3001023","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":402.0,"discounted_cash":241.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASCORBIC ACID (VITAMIN C), BLOOD, VITC","code_information":[{"code":"3001024","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.0,"discounted_cash":536.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":866.0,"discounted_cash":519.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF BETA-2 MICROGLOBULIN","code_information":[{"code":"3001026","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":529.0,"discounted_cash":317.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO BIOTINIDASE,EACH BIOTS","code_information":[{"code":"3001027","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82261","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CADIUM OCCUP MONITOR BLOOD CDOMB","code_information":[{"code":"3001028","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CALCITONIN CATN","code_information":[{"code":"3001029","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CALCIUM; TOTAL","code_information":[{"code":"3001030","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IONIZED CALCIUM","code_information":[{"code":"3001031","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":299.0,"discounted_cash":179.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF CALCIUM IN URINE","code_information":[{"code":"3001032","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO KIDNEY STONE ANALYSIS CASA","code_information":[{"code":"3001033","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":209.0,"discounted_cash":125.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CARCINOEMBRYONIC ANTIGEN (CEA); CEAPC","code_information":[{"code":"3001034","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":390.0,"discounted_cash":234.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF CARNITINE CARNS","code_information":[{"code":"3001035","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":379.0,"discounted_cash":227.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CATECHOLAMINES; URINE; CATU","code_information":[{"code":"3001036","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":374.0,"discounted_cash":224.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CHEMILUMINESCENT ASSAY; PTHRP","code_information":[{"code":"3001037","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":245.0,"discounted_cash":147.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE CHLORIDE","code_information":[{"code":"3001038","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CHOLINESTERASE, RBC; ACHS","code_information":[{"code":"3001039","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82482","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CHROMIUM; CRS","code_information":[{"code":"3001041","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CITRATE EXCRETION, 24 HR URINE CITR","code_information":[{"code":"3001042","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":344.0,"discounted_cash":206.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COLLAGEN CROSS LINKS, ANY METHOD; CTX","code_information":[{"code":"3001044","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":298.0,"discounted_cash":178.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF COPPER; CUS","code_information":[{"code":"3001045","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CORTISOL, FREE; CORTU","code_information":[{"code":"3001046","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":181.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TOTAL CORTISOL; SALCT","code_information":[{"code":"3001047","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":311.0,"discounted_cash":186.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GC/MS,QUANT,SINGLE STATIONARY PHASE","code_information":[{"code":"3001048","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":626.0,"discounted_cash":375.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CREATININE, OTHER SOURCE","code_information":[{"code":"3001052","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":87.0,"discounted_cash":52.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DIHYDROXYVITAMIN D, 1,25; DHVD","code_information":[{"code":"3001055","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":510.0,"discounted_cash":306.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ENZYME ACTIVITY EA SPECIMEN; FDISP","code_information":[{"code":"3001057","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":562.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":884.0,"discounted_cash":530.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LYSOSOMAL STORAGE DISORDER, NEONATAL SCREEN","code_information":[{"code":"3001058","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"3001059","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":304.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":328.0,"discounted_cash":196.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ESTRIOL; UE3","code_information":[{"code":"3001060","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ESTRONE; E1","code_information":[{"code":"3001061","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ETHYLENE GLYCOL","code_information":[{"code":"3001062","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":253.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":386.0,"discounted_cash":231.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FAT/LIPIDS, FECES; QUANT; FATF","code_information":[{"code":"3001063","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82710","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":302.0,"discounted_cash":181.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FATTY ACIDS, NONESTERIFIED; NEFA","code_information":[{"code":"3001064","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":302.0,"discounted_cash":181.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO LONG CHAIN FATTY ACIDS; POX","code_information":[{"code":"3001065","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.0,"discounted_cash":645.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1014.0,"discounted_cash":608.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GALACTOSE-1 PHOS URIDYL TRANSFER","code_information":[{"code":"3001066","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82775","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":774.0,"discounted_cash":464.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ART BLOOD GASES: PH, PO2, & PC02","code_information":[{"code":"3001067","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":398.0,"discounted_cash":238.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO GASTRIN; GAST","code_information":[{"code":"3001068","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GLUCOSE; QUANT, BLOOD","code_information":[{"code":"3001069","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":78.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":118.0,"discounted_cash":70.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF G6PD ENZYME G6PO","code_information":[{"code":"3001070","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO GLYCATED PROTEIN-BOUND; FRUCT","code_information":[{"code":"3001071","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HEMOGLOBIN; GLYCOSYLATED; HBA1C","code_information":[{"code":"3001072","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":137.0,"discounted_cash":82.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF HISTAMINE; FHSPL","code_information":[{"code":"3001073","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HOMOCYSTINE; HCYSU","code_information":[{"code":"3001074","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HOMOVANILLIC ACID (HVA); HVAR","code_information":[{"code":"3001075","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":232.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HOMOVANILLIC ACID 5-HIAA (HVA); HIAA","code_information":[{"code":"3001076","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF PROGESTERONE; OHPG","code_information":[{"code":"3001077","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":329.0,"discounted_cash":197.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY,OTH QL,SEMQT,MLTISIP","code_information":[{"code":"3001078","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":230.0,"discounted_cash":138.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY,OTH QL,SEMQT,MLTISIP","code_information":[{"code":"3001079","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":5019.0,"discounted_cash":3011.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4593.0,"discounted_cash":2755.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY,OTH QL,SEMQT,MLTISIP","code_information":[{"code":"3001080","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":953.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1454.0,"discounted_cash":872.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOGLOBULIN BINDING PROTEIN","code_information":[{"code":"3001081","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1093.0,"discounted_cash":655.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":999.0,"discounted_cash":599.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001082","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":545.0,"discounted_cash":327.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001083","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1487.0,"discounted_cash":892.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1360.0,"discounted_cash":816.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LEAD, BLOOD","code_information":[{"code":"3001084","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":165.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LIPOPROTIEN ASSOC PHOSPHLIPASE A2","code_information":[{"code":"3001085","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":654.0,"discounted_cash":392.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LIPOPROTEIN, BLOOD; QUANT PART SUBCL","code_information":[{"code":"3001086","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":359.0,"discounted_cash":215.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LIPOPROTEIN, HDL CHOLESTEROL","code_information":[{"code":"3001087","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MAGNESIUM","code_information":[{"code":"3001088","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MASS SPECTROMETRY;QUANTITATIVE EA","code_information":[{"code":"3001089","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":163.0,"discounted_cash":97.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MASS SPECTROMETRY;QUANTITATIVE EA","code_information":[{"code":"3001090","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF MERCURY","code_information":[{"code":"3001091","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":162.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC METANEPHRINES","code_information":[{"code":"3001092","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MUCOPOLYSACCHARIDES QUANT","code_information":[{"code":"3001095","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MUCOPOLYSACCHARIDES QUANT","code_information":[{"code":"3001096","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":667.0,"discounted_cash":400.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ORGANIC ACIDS,QUALITATIVE; OAU","code_information":[{"code":"3001123","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":424.0,"discounted_cash":254.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ORGANIC ACIDS,QUALITATIVE","code_information":[{"code":"3001124","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":724.0,"discounted_cash":434.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO METHYLMALONIC ACID QUANT SERUM MMAS","code_information":[{"code":"3001125","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":243.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC OXALATE","code_information":[{"code":"3001127","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":229.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":348.0,"discounted_cash":208.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PHENCYCLIDINE FPHNC","code_information":[{"code":"3001128","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":317.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":497.0,"discounted_cash":298.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CALPROTECTIN, FECAL","code_information":[{"code":"3001129","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.0,"discounted_cash":628.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1018.0,"discounted_cash":610.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PHENYLALANINE (PKU) BLOOD; PKU","code_information":[{"code":"3001130","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":222.0,"discounted_cash":133.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PHENYLALANINE (PKU) BLOOD","code_information":[{"code":"3001131","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PHOSPHATASE, ALKALINE ALKI","code_information":[{"code":"3001132","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":120.0,"discounted_cash":72.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PHOSPHATASE, ALKALINE; ISOENZYMES ALKI","code_information":[{"code":"3001133","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PHOSPHORUS","code_information":[{"code":"3001134","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":131.0,"discounted_cash":78.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINE PHOSPHORUS","code_information":[{"code":"3001135","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":131.0,"discounted_cash":78.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PORPHOBILINOGEN, URINE; PBGU","code_information":[{"code":"3001136","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":314.0,"discounted_cash":188.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PORPHOBILINOGEN, URINE; PQNU","code_information":[{"code":"3001137","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF URINE PORPHYRINS; PQNU","code_information":[{"code":"3001138","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC POTASSIUM; SERUM","code_information":[{"code":"3001139","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":124.0,"discounted_cash":74.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PREGNENOLONE; PREGN","code_information":[{"code":"3001140","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":594.0,"discounted_cash":356.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PREGNANCY ASSOC PLASMA PROT","code_information":[{"code":"3001141","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84163","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PROTEIN ELECTROPHORESIS, FLUID; EBF","code_information":[{"code":"3001142","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO WESTERN BLOT, BLOOD OR BODY FLD; FMGA","code_information":[{"code":"3001143","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":400.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":627.0,"discounted_cash":376.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO REFLEX CRMP-5 IGG WEST BLOT CRMWS","code_information":[{"code":"3001144","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":637.0,"discounted_cash":382.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST","code_information":[{"code":"3001145","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":593.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":905.0,"discounted_cash":543.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST","code_information":[{"code":"3001146","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1372.0,"discounted_cash":823.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY RBC PROTOPORPHYRIN; NEZPP","code_information":[{"code":"3001147","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84202","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":552.0,"discounted_cash":331.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF PROINSULIN; PINS","code_information":[{"code":"3001148","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":338.0,"discounted_cash":202.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF VITAMIN B-6; PLP","code_information":[{"code":"3001149","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":715.0,"discounted_cash":429.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF PYRUVATE; PYR","code_information":[{"code":"3001150","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":241.0,"discounted_cash":144.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF PYRUVATE KINASE; PK","code_information":[{"code":"3001151","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84220","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":241.0,"discounted_cash":144.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO RECEPTOR ASSAY;NON-ENDOCRINE; STFR","code_information":[{"code":"3001152","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":280.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":440.0,"discounted_cash":264.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF RENIN; PRA","code_information":[{"code":"3001153","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF VITAMIN B-2; VITB2","code_information":[{"code":"3001154","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":218.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF SELENIUM; SES, LC 716910","code_information":[{"code":"3001155","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF SEROTONIN; SERWB","code_information":[{"code":"3001156","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF SEX HORMONE BINDNG GLOBULIN; SHBG","code_information":[{"code":"3001157","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":206.0,"discounted_cash":123.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SODIUM; SERUM","code_information":[{"code":"3001158","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":109.0,"discounted_cash":65.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF SOMATOMEDIN IGFMS","code_information":[{"code":"3001159","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":246.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":386.0,"discounted_cash":231.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SUGARS (MONO,DI,OLIGO)SINGLE QUAL","code_information":[{"code":"3001160","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SULFATE, URINE","code_information":[{"code":"3001161","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF TOTAL TESTOSTERONE FRTST/TGRP","code_information":[{"code":"3001162","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THIAMINE (VITAMIN B-1) TDP","code_information":[{"code":"3001163","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":307.0,"discounted_cash":184.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF THIOCYANATE","code_information":[{"code":"3001164","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84430","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":260.0,"discounted_cash":156.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF THRYOID BINDING GLOBULIN TBGS","code_information":[{"code":"3001165","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":214.0,"discounted_cash":128.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF THYROID STIM IMMUNE GLOB; TSI","code_information":[{"code":"3001166","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":383.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":603.0,"discounted_cash":361.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF VITAMIN E; VITE","code_information":[{"code":"3001167","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC THYROID UPTAKE (T3&T4) OR THBR","code_information":[{"code":"3001168","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":188.0,"discounted_cash":112.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TRIIODOTHYRONINE T3; REVERSE; RT3","code_information":[{"code":"3001169","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":335.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TYROSINE BLOOD; PKU","code_information":[{"code":"3001170","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84510","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VANILLYLMANDELIC ACID (VMA), URINE; VMA","code_information":[{"code":"3001171","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":260.0,"discounted_cash":156.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VASO1 INTESTINAL PEPTIDE (VIP); VIP","code_information":[{"code":"3001172","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VASOPRESSIN (ANTIDIURETIC HORMONE, ADH)","code_information":[{"code":"3001173","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":335.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":527.0,"discounted_cash":316.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VITAMIN A; VITA","code_information":[{"code":"3001174","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":151.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VITAMIN K1 SERUM VITK1","code_information":[{"code":"3001175","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF ZINC; ZNS","code_information":[{"code":"3001176","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GONADOTROPIN, CHORIONIC (HCG), QUANT","code_information":[{"code":"3001177","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":370.0,"discounted_cash":222.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD COUNT; HEMATOCRIT","code_information":[{"code":"3001178","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":92.0,"discounted_cash":55.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR VIII, VW FACTOR ANTIGEN","code_information":[{"code":"3001179","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":681.0,"discounted_cash":408.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR VIII VW FACTOR, MULTIMERIC (SO)","code_information":[{"code":"3001180","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":288.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":439.0,"discounted_cash":263.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR XIII, FIBRIN STABILIZING","code_information":[{"code":"3001181","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85290","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":514.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":784.0,"discounted_cash":470.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR XIII,SCREEN INHIBITOR","code_information":[{"code":"3001182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":488.0,"discounted_cash":292.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTITHROMBIN III, ANTIGEN ASSAY; ATTI","code_information":[{"code":"3001183","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":303.0,"discounted_cash":181.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PROTEIN C ANTI PLASMA PCAG","code_information":[{"code":"3001184","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":374.0,"discounted_cash":224.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PROTEIN S ANTI TOTAL PST","code_information":[{"code":"3001185","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.0,"discounted_cash":267.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":433.0,"discounted_cash":259.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PROTEIN S ANTI FREE PLASMA PSTF","code_information":[{"code":"3001186","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":402.0,"discounted_cash":241.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FACTOR INHIBITOR TEST","code_information":[{"code":"3001187","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.0,"discounted_cash":841.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1283.0,"discounted_cash":769.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ALPHA-2 ANTIPLASMIN; APSM","code_information":[{"code":"3001189","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85410","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":341.0,"discounted_cash":204.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PLASMINOGEN ACTIVATOR","code_information":[{"code":"3001190","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1029.0,"discounted_cash":617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":941.0,"discounted_cash":564.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FIBRINOLYTIC PLASMINOGEN; PSGN","code_information":[{"code":"3001191","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":232.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":364.0,"discounted_cash":218.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MURAMIDASE-LYSOZYME; MUR","code_information":[{"code":"3001192","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":212.0,"discounted_cash":127.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO OSMOTIC FRAGILITY, RBC; INCUBATED; FRAG","code_information":[{"code":"3001193","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85557","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":229.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":360.0,"discounted_cash":216.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO BLOOD VISCOSITY EXAMINATION; VISCS","code_information":[{"code":"3001194","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":173.0,"discounted_cash":103.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ALLERGEN SPECIFIC  IGE","code_information":[{"code":"3001195","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":65.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO WBC ANTIBODY IDENTIFICATION LAGGT","code_information":[{"code":"3001196","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":400.0,"discounted_cash":240.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY ID; PLATELET-HEPARIN DEPEND AB PLAB","code_information":[{"code":"3001197","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY ID; PLATELET-HEPARIN DEPEND AB; FPORC","code_information":[{"code":"3001198","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":1069.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1681.0,"discounted_cash":1008.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTISTREPTOLYSIN; TITER; SABP","code_information":[{"code":"3001199","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":141.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":220.0,"discounted_cash":132.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COMPLEMENT; TOTAL (CH50); COM","code_information":[{"code":"3001200","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":324.0,"discounted_cash":194.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DEOXYRIBONUCLEASE, ANTIBODY; SABP","code_information":[{"code":"3001201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":182.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FLUORESCENT ANTIBODY, SCREEN RTA","code_information":[{"code":"3001202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":181.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLUORESCENT ANTIBODY, TITER","code_information":[{"code":"3001204","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY, TUMOR CA 15-3 (27.29); C2729","code_information":[{"code":"3001205","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY, TUMOR CA 19-9 CAPC","code_information":[{"code":"3001206","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"discounted_cash":371.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":584.0,"discounted_cash":350.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY, TUMOR CA 19-9; CA19","code_information":[{"code":"3001207","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY, TUMOR OTHER; CGAK","code_information":[{"code":"3001208","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY, TUMOR OTHER; F100B","code_information":[{"code":"3001209","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":498.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":782.0,"discounted_cash":469.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INHIBIN A; INHA","code_information":[{"code":"3001210","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":146.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":230.0,"discounted_cash":138.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INSULIN ANTIBODIES INAB, FINAB","code_information":[{"code":"3001211","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":322.0,"discounted_cash":193.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INTRINSIC FACTOR BLOCKING AB; IFBA","code_information":[{"code":"3001212","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":228.0,"discounted_cash":136.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ISLET CELL ANTIBODY IA2, FIAAB","code_information":[{"code":"3001213","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"discounted_cash":637.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1000.0,"discounted_cash":600.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY, ADENOVIRUS","code_information":[{"code":"3001214","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86603","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; ASPERGILLUS","code_information":[{"code":"3001215","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; CRYPTOCOCCUS","code_information":[{"code":"3001216","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":251.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":383.0,"discounted_cash":229.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; CYTOMEGALOVIRUS","code_information":[{"code":"3001217","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; CYTOMEGALOVIRUS, IGM","code_information":[{"code":"3001218","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; DIPHTHERIA","code_information":[{"code":"3001219","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86648","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY, ENTEROVIRUS","code_information":[{"code":"3001220","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY, EHRLICHIA; EHRC","code_information":[{"code":"3001221","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HELICOBACTER PYLORI","code_information":[{"code":"3001222","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":288.0,"discounted_cash":172.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HTLV/HIV ANTIBODY, CONFIRM","code_information":[{"code":"3001223","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":263.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":333.0,"discounted_cash":199.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; HTLV/HIV ANTIBODY, CONFIRM HTLVL","code_information":[{"code":"3001224","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":429.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":676.0,"discounted_cash":405.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HEPATITIS B CORE ANTIBODY; TOTAL; HBC","code_information":[{"code":"3001226","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":214.0,"discounted_cash":128.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HEPATITIS BE ANTIBODY; HEAB","code_information":[{"code":"3001227","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEPATITIS A ANTIBODY; TOTAL","code_information":[{"code":"3001228","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; INFLUENZA VIRUS","code_information":[{"code":"3001229","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; LEGIONELLA LEGPA","code_information":[{"code":"3001230","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY;LYMPHOCYT CHORIOMENINGITIS","code_information":[{"code":"3001231","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; MUMPS, FMCPL CSF","code_information":[{"code":"3001232","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; MUMPS, MMPM, ZW83","code_information":[{"code":"3001233","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; RUBEOLA, ROM","code_information":[{"code":"3001234","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":195.0,"discounted_cash":117.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; TETANUS","code_information":[{"code":"3001235","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; VARICELLA-ZOSTER","code_information":[{"code":"3001236","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; WEST NILE VIRUS, IGM","code_information":[{"code":"3001237","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO WEST NILE VIRUS AB CSF IGMAB/WNC","code_information":[{"code":"3001238","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANTIBODY; WEST NILE VIRUS,","code_information":[{"code":"3001239","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO WEST NILE VIRUS AB CSF IGGAB/WNC","code_information":[{"code":"3001240","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CONCENTRATION, FOR INFECTIOUS AGENTS","code_information":[{"code":"3001241","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":136.0,"discounted_cash":81.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE, DEFINITIVE ID, MOLD","code_information":[{"code":"3001242","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CULT TYPE IMMUNOFLUOR EA, FCTRC","code_information":[{"code":"3001244","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SMEAR, COMPLEX SP STAIN, OVA & PARASITES; OAP","code_information":[{"code":"3001245","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":199.0,"discounted_cash":119.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VIRAL TISSUE INOCULATION, OBSV, ID; VIRNR","code_information":[{"code":"3001246","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":461.0,"discounted_cash":276.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AG DETECT ENZYME IMMUNO ASPERGILLUS; ASPAG","code_information":[{"code":"3001248","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HELICOBACTER PYLORI-STOOL, ANTIGEN, EIA; HPSA","code_information":[{"code":"3001249","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":208.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":329.0,"discounted_cash":197.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HEPATITIS BE ANTIGEN; EAG","code_information":[{"code":"3001250","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":186.0,"discounted_cash":111.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HISTOPLASMA CAPSULATUM","code_information":[{"code":"3001251","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":513.0,"discounted_cash":307.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INF ANTIGEN NOS, MULT STEP, EIA","code_information":[{"code":"3001252","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":610.0,"discounted_cash":366.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO LYME DISEASE, MOLECULAR DETECT, PCR; PBORR","code_information":[{"code":"3001253","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":433.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE","code_information":[{"code":"3001254","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":398.0,"discounted_cash":238.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ENTEROVIRUS MOLECULAR DETECT PCR LENT","code_information":[{"code":"3001256","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":398.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":644.0,"discounted_cash":386.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HEPATITIS B VIRUS,QUANT,DNA DETECT; HBVQU","code_information":[{"code":"3001257","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":439.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":691.0,"discounted_cash":414.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEPATITS C,AMPLIFIED PROBE TECHNIQUE","code_information":[{"code":"3001258","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87521","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":544.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":692.0,"discounted_cash":415.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MYCOBACTERIA TB,AMPLIFD PROBE TECH","code_information":[{"code":"3001260","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":408.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":624.0,"discounted_cash":374.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC M PNEUMONIA,AMP PROBE","code_information":[{"code":"3001261","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.0,"discounted_cash":584.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":893.0,"discounted_cash":535.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC NEISSERIA GONORRHOEAE, LCX","code_information":[{"code":"3001262","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":198.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":284.0,"discounted_cash":170.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INF AGENT DET, NOS AMPL PROBE","code_information":[{"code":"3001263","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":1486.0,"discounted_cash":891.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1361.0,"discounted_cash":816.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH INF AG DET AMP PRB LAB TEST","code_information":[{"code":"3001264","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":610.0,"discounted_cash":366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":591.0,"discounted_cash":354.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INF AGENT,DNA OR RNA,QUANT EA; QBKU","code_information":[{"code":"3001265","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1150.0,"discounted_cash":690.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INF AGENT,DNA OR RNA,QUANT EA; QBK","code_information":[{"code":"3001266","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":516.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":811.0,"discounted_cash":486.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INF AGENT,DNA OR RNA,QUANT EA; FJCV","code_information":[{"code":"3001267","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1401.0,"discounted_cash":840.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1320.0,"discounted_cash":792.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INFECTIOUS AGENT NOS, DIRECT OBS; SPNEU","code_information":[{"code":"3001268","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GENOTYPE ANALYS,HIV-1,REVERSE TRANS","code_information":[{"code":"3001269","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":2419.0,"discounted_cash":1451.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1846.0,"discounted_cash":1107.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLOW CYTOMETRY 1ST SURF MARKER","code_information":[{"code":"3001270","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":335.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":555.0,"discounted_cash":333.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TISSUE CULTURE,NEOPLASTIC,SLD TUM","code_information":[{"code":"3001272","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":4373.0,"discounted_cash":2623.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4119.0,"discounted_cash":2471.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TISSUE CULTURE,NEOPLASTIC,SLD TUM","code_information":[{"code":"3001273","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":5626.0,"discounted_cash":3375.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5304.0,"discounted_cash":3182.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CRYOPRESERVATION, EACH CELL LINE","code_information":[{"code":"3001274","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":364.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":572.0,"discounted_cash":343.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CRYOPRESERVATION, EACH CELL LINE","code_information":[{"code":"3001275","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1689.0,"discounted_cash":1013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1589.0,"discounted_cash":953.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COAG & FIBRINOLYSIS, FUNC NOS, ADM13","code_information":[{"code":"3001277","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":499.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":747.0,"discounted_cash":448.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SUGARS (MONO-DI-OLIGO) SNGL QT EA SPEC; GAL1P","code_information":[{"code":"3001278","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV-1 INTEGRASE GENO FHIG","code_information":[{"code":"3001280","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":2342.0,"discounted_cash":1405.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2272.0,"discounted_cash":1363.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ACETYLCHOLINESTERASE","code_information":[{"code":"3001281","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HTLV-1; HTLVI","code_information":[{"code":"3001282","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86687","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":283.0,"discounted_cash":169.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ID BY PULSE FIELD GEL TYPING","code_information":[{"code":"3001283","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87152","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":374.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":569.0,"discounted_cash":341.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DR/DQ, SINGLE ANTIGEN","code_information":[{"code":"3001284","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86816","type":"HCPCS"}],"standard_charges":[{"gross_charge":645.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":590.0,"discounted_cash":354.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC QUANTITATIVE ASSAY, DRUG","code_information":[{"code":"3001285","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GAMMAGLOB, IGA, IGD, IGG, IGM,EA","code_information":[{"code":"3001288","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":193.0,"discounted_cash":115.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IGG SUBCLASSES","code_information":[{"code":"3001289","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":158.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":242.0,"discounted_cash":145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOGLOBULIN BINDING PROTEIN","code_information":[{"code":"3001290","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":455.0,"discounted_cash":273.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001291","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":341.0,"discounted_cash":204.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY, ANALYTE, QUANT, NOS C4BP","code_information":[{"code":"3001292","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":463.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":727.0,"discounted_cash":436.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001293","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1072.0,"discounted_cash":643.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NEPHELOMETRY ASSAY,NOS KAP/TLCU","code_information":[{"code":"3001294","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OLIGOCLONAL BANDS","code_information":[{"code":"3001322","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":337.0,"discounted_cash":202.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF TESTOSTERONE FREE FRTST/TGRP","code_information":[{"code":"3001323","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BETA 2 GLYCOPROTEIN ANTIBODY EA B2GLY","code_information":[{"code":"3001324","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":238.0,"discounted_cash":142.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIPHOSPHATYDLSERINE","code_information":[{"code":"3001325","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":354.0,"discounted_cash":212.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTI BARTONELLA B.HENSELAE IGG BART","code_information":[{"code":"3001326","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":103.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LYME DISEASE IGG AB LYWB LAB TEST","code_information":[{"code":"3001327","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":283.0,"discounted_cash":169.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CHLAMYDIA C.TRACHOMATIS IGG SCLAM","code_information":[{"code":"3001328","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO CHLAMYDIA C.TRACHOMATIS IGM SCLAM","code_information":[{"code":"3001329","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":105.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ANTIBODY, COXIELLA BRUNETTI IGG, QFP","code_information":[{"code":"3001330","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANTIBODY; ENCEPH, CALIFORNIA","code_information":[{"code":"3001331","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; ENCEPHALITIS, EASTERN","code_information":[{"code":"3001332","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; ENCEPHALITIS, ST. LOUIS","code_information":[{"code":"3001333","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; ENCEPHALITIS, WESTERN","code_information":[{"code":"3001334","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY, ENTEROVIRUS; COXA","code_information":[{"code":"3001335","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FUNGUS,NOT ELSEWHERE SPECIFIED","code_information":[{"code":"3001336","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HERPES SIMPLEX, TYPE 1","code_information":[{"code":"3001338","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HERPES SIMPLEX, TYPE 2","code_information":[{"code":"3001339","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; HISTOPLASMA","code_information":[{"code":"3001340","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INFULENZA VIRUS A SERUM IGG/SFLA","code_information":[{"code":"3001341","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY; PARVOVIRUS; PARV","code_information":[{"code":"3001342","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO BABESIA MICROTI ANTI IGG FBAB","code_information":[{"code":"3001343","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO RICKETTSIA IGG AB SFGP","code_information":[{"code":"3001344","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":245.0,"discounted_cash":147.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; RUBEOLA","code_information":[{"code":"3001345","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLOW CYTOMETRY 1ST SURF MARKER","code_information":[{"code":"3001346","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":378.0,"discounted_cash":226.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO BCR/ABL1 GENE MAJOR BP; BCRAB","code_information":[{"code":"3001352","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2042.0,"discounted_cash":1225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1924.0,"discounted_cash":1154.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CFTR GENE COM VARIANTS","code_information":[{"code":"3001364","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3657.0,"discounted_cash":2194.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3447.0,"discounted_cash":2068.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CFTR GENE KNOWN FAM VARIANTS","code_information":[{"code":"3001365","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2345.0,"discounted_cash":1407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2212.0,"discounted_cash":1327.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CFTR GENE DUP/DELET VARIANTS CFTRZ","code_information":[{"code":"3001366","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3831.0,"discounted_cash":2298.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3720.0,"discounted_cash":2232.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CFTR GENE FULL SEQUENCE CFTRZ","code_information":[{"code":"3001367","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":3831.0,"discounted_cash":2298.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3720.0,"discounted_cash":2232.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYP2D6 GENE COM VARIANTS","code_information":[{"code":"3001370","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81226","type":"HCPCS"}],"standard_charges":[{"gross_charge":4023.0,"discounted_cash":2413.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3790.0,"discounted_cash":2274.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTOGEN MICRARRAY COPY NMBR","code_information":[{"code":"3001372","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81228","type":"HCPCS"}],"standard_charges":[{"gross_charge":8998.0,"discounted_cash":5398.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":8482.0,"discounted_cash":5089.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MSH6 GENE KNOWN VARIANTS","code_information":[{"code":"3001373","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":9501.0,"discounted_cash":5700.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":7462.0,"discounted_cash":4477.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC EGFR GENE COM VARIANTS","code_information":[{"code":"3001374","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":9323.0,"discounted_cash":5593.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":8788.0,"discounted_cash":5272.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC F2 GENE LAB TEST","code_information":[{"code":"3001375","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":556.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":899.0,"discounted_cash":539.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC F5 GENE LAB TEST","code_information":[{"code":"3001376","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":556.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":899.0,"discounted_cash":539.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FMR1 GENE DETECTION FXS","code_information":[{"code":"3001378","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":1761.0,"discounted_cash":1056.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1708.0,"discounted_cash":1024.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FMR1 GENE CHARACTERIZATION","code_information":[{"code":"3001379","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81244","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":852.0,"discounted_cash":511.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLT3 GENE","code_information":[{"code":"3001380","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1907.0,"discounted_cash":1144.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1798.0,"discounted_cash":1078.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HFE GENE","code_information":[{"code":"3001387","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":1283.0,"discounted_cash":769.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1208.0,"discounted_cash":724.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IKBKAP GENE","code_information":[{"code":"3001389","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":1811.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2844.0,"discounted_cash":1706.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IGH VARI REGIONAL MUTATION; BCLL","code_information":[{"code":"3001392","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":2638.0,"discounted_cash":1582.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2486.0,"discounted_cash":1491.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC STR MARKERS SPECIMEN ANAL","code_information":[{"code":"3001394","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":873.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1375.0,"discounted_cash":825.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO JAK2 GENE; JAK2B","code_information":[{"code":"3001398","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":1188.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1867.0,"discounted_cash":1120.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC KRAS GENE","code_information":[{"code":"3001399","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1682.0,"discounted_cash":1009.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MTHFR GENE MTHFR","code_information":[{"code":"3001404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1593.0,"discounted_cash":955.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1501.0,"discounted_cash":900.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MECP2 GENE FULL SEQ MECPZ","code_information":[{"code":"3001415","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81302","type":"HCPCS"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":1152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1864.0,"discounted_cash":1118.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MECP2 GENE DUP/DELET VARIANT MECPZ","code_information":[{"code":"3001417","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81304","type":"HCPCS"}],"standard_charges":[{"gross_charge":1920.0,"discounted_cash":1152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1864.0,"discounted_cash":1118.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NPM1 GENE; NPM1","code_information":[{"code":"3001418","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1828.0,"discounted_cash":1096.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1722.0,"discounted_cash":1033.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PML/RARALPHA COM BREAKPOINTS; PMLR","code_information":[{"code":"3001419","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1226.0,"discounted_cash":735.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1153.0,"discounted_cash":691.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PMP22 GENE DUP/DELET","code_information":[{"code":"3001427","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81324","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.0,"discounted_cash":2161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3394.0,"discounted_cash":2036.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PMP22 GENE FULL SEQUENCE","code_information":[{"code":"3001428","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81325","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.0,"discounted_cash":2161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3394.0,"discounted_cash":2036.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SNRPN/UBE3A GENE HNP","code_information":[{"code":"3001431","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":2530.0,"discounted_cash":1518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2386.0,"discounted_cash":1431.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TRB GENE REARRANGE AMPLIFY; TCGBM","code_information":[{"code":"3001433","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":760.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1194.0,"discounted_cash":716.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TRG GENE REARRANGEMENT ANAL; TCGBM","code_information":[{"code":"3001435","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.0,"discounted_cash":760.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1194.0,"discounted_cash":716.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HLA I TYPING COMPLETE LR; DISI","code_information":[{"code":"3001440","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"discounted_cash":882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1386.0,"discounted_cash":831.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HLA II TYPING 1 LOCUS LR CELI","code_information":[{"code":"3001444","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":287.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HLA I TYPING 1 ALLELE HR; HLA57","code_information":[{"code":"3001449","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HLA II TYPING 1 LOC HR","code_information":[{"code":"3001450","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":1967.0,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1854.0,"discounted_cash":1112.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 1 HNP","code_information":[{"code":"3001452","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":1503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2360.0,"discounted_cash":1416.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 4","code_information":[{"code":"3001455","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":1125.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1770.0,"discounted_cash":1062.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 5","code_information":[{"code":"3001456","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.0,"discounted_cash":2161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3394.0,"discounted_cash":2036.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 6","code_information":[{"code":"3001457","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.0,"discounted_cash":2161.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3394.0,"discounted_cash":2036.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 7","code_information":[{"code":"3001458","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4322.0,"discounted_cash":2593.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3394.0,"discounted_cash":2036.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 8 SCN1A","code_information":[{"code":"3001459","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":9623.0,"discounted_cash":5773.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":9071.0,"discounted_cash":5442.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CEPH 4 PLEX INF A&B, RSV, COVID 19, MOLECULAR","code_information":[{"code":"3001470","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC RESP VIR 12-25 TARGETS LAB TEST","code_information":[{"code":"3001472","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.0,"discounted_cash":774.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1254.0,"discounted_cash":752.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DESOXYCORTICOSTERONE, 11","code_information":[{"code":"3001476","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":559.0,"discounted_cash":335.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FETAL CONGENITAL ABNORMALITIES QUAD1","code_information":[{"code":"3001482","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81511","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BILIRUBIN, TOTAL, TRANSCUTANEOUS","code_information":[{"code":"3001487","type":"CDM"},{"code":"0300","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":124.0,"discounted_cash":74.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY SCREEN, EACH SERUM TECHNIQUE","code_information":[{"code":"3001488","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":124.0,"discounted_cash":74.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC FACTOR INHIBITOR TEST","code_information":[{"code":"3001489","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.0,"discounted_cash":841.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1283.0,"discounted_cash":769.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PLATELET; AGGREGATION","code_information":[{"code":"3001490","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COMPATIBILITY TEST, EA UNIT; INCUBATION","code_information":[{"code":"3001491","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86921","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ASSAY, AMINOLEVULINIC ACID","code_information":[{"code":"3001492","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":363.0,"discounted_cash":217.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; DIRECT","code_information":[{"code":"3001493","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC ANTIBODY SCREEN, EACH SERUM TECHNIQUE","code_information":[{"code":"3001495","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":277.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":422.0,"discounted_cash":253.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC CULTURE TYPING;ID BY NUCL ACID PROBE","code_information":[{"code":"3001496","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87149","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":328.0,"discounted_cash":196.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC INFECTIOUS AGENT NOS, DIRECT OBS","code_information":[{"code":"3001497","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":78.0,"discounted_cash":46.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC ANTIBODY; HERPES SIMPLEX, TYPE 1","code_information":[{"code":"3001499","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":124.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC ANTIBODY; HERPES SIMPLEX, TYPE 2","code_information":[{"code":"3001500","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO HLA II TYPING 1 LOCUS LR CELI EA ADDTL","code_information":[{"code":"3001501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":287.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MOPATH PROCEDURE LEVEL 5","code_information":[{"code":"3001502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.0,"discounted_cash":2161.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":3394.0,"discounted_cash":2036.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC MOPATH PROCEDURE LEVEL 6","code_information":[{"code":"3001503","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3602.0,"discounted_cash":2161.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":3394.0,"discounted_cash":2036.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001504","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3462.0,"discounted_cash":2077.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":3170.0,"discounted_cash":1902.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC HLA II TYPING 1 LOC HR","code_information":[{"code":"3001505","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":1967.0,"discounted_cash":1180.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":1854.0,"discounted_cash":1112.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC HLA II TYPING 1 LOC HR","code_information":[{"code":"3001506","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":481.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":755.0,"discounted_cash":453.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HLA II TYPING 1 LOC HR","code_information":[{"code":"3001507","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":802.0,"discounted_cash":481.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":755.0,"discounted_cash":453.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001509","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1558.0,"discounted_cash":934.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1424.0,"discounted_cash":854.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO UNLISTED MOLECULAR PATHOLOGY PROC GCN1A","code_information":[{"code":"3001510","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":9623.0,"discounted_cash":5773.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":9071.0,"discounted_cash":5442.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HANDLING AND/OR CONVEYANCE OF SPECIMEN","code_information":[{"code":"3001511","type":"CDM"},{"code":"0300","type":"RC"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":26.0,"discounted_cash":15.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 7; FCCEV","code_information":[{"code":"3001512","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":14761.0,"discounted_cash":8856.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":13913.0,"discounted_cash":8347.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 5 HNP","code_information":[{"code":"3001514","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":7507.0,"discounted_cash":4504.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":7077.0,"discounted_cash":4246.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HANDLING AND/OR CONVEYANCE OF SPECIMEN","code_information":[{"code":"3001515","type":"CDM"},{"code":"0300","type":"RC"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANTIBODY ID; PLATELET-HEPARIN DEPEND AB","code_information":[{"code":"3001517","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1422.0,"discounted_cash":853.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1301.0,"discounted_cash":780.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF PHENYTOIN, TOTAL PNTFT","code_information":[{"code":"3001518","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF ARSENIC","code_information":[{"code":"3001533","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CATECHOLAMINES, PLASMA; CATP","code_information":[{"code":"3001535","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":374.0,"discounted_cash":224.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CITRATE","code_information":[{"code":"3001536","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":361.0,"discounted_cash":216.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TELOPEPTIDE URINE NTXPR","code_information":[{"code":"3001537","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF COPPER, CUU","code_information":[{"code":"3001538","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ESTRONE","code_information":[{"code":"3001539","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":275.0,"discounted_cash":165.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TTG IGA LAB TEST","code_information":[{"code":"3001540","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":42.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MAGNESIUM","code_information":[{"code":"3001541","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":289.0,"discounted_cash":173.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF MERCURY","code_information":[{"code":"3001542","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":271.0,"discounted_cash":162.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ORGANIC ACID, SINGLE, QUANT; OROT","code_information":[{"code":"3001543","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO OXALATE 24 HR URINE OXU","code_information":[{"code":"3001544","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PHENYLALANINE (PKU) BLOOD","code_information":[{"code":"3001545","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":310.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF TOTAL TESTOSTERONE TTST/TTFB","code_information":[{"code":"3001546","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC C3 COMP GLOB B-1C LAB TEST","code_information":[{"code":"3001547","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CRYOPRESERVATION, EACH CELL LINE","code_information":[{"code":"3001549","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1689.0,"discounted_cash":1013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1589.0,"discounted_cash":953.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC MMUNO MLTISIP ADL LAB TEST","code_information":[{"code":"3001550","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":65.0,"discounted_cash":39.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC URINE PROTEIN LAB TEST","code_information":[{"code":"3001551","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLUORESCENT ANTIBODY, TITER","code_information":[{"code":"3001552","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO QUANTITATIVE ASSAY, DRUG ITRA","code_information":[{"code":"3001553","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001555","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3462.0,"discounted_cash":2077.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3170.0,"discounted_cash":1902.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GAMMAGLOB, IGA, IGD, IGG, IGM,EA","code_information":[{"code":"3001556","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":545.0,"discounted_cash":327.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF PHENYTOIN, TOTAL","code_information":[{"code":"3001557","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":316.0,"discounted_cash":189.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE POTASSIUM","code_information":[{"code":"3001559","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE SODIUM","code_information":[{"code":"3001560","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":136.0,"discounted_cash":81.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE/URC OTH SOURCE","code_information":[{"code":"3001561","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF URINE/URC OTH SOURCE","code_information":[{"code":"3001562","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MICROSOMAL ANTIBODIES; LKM","code_information":[{"code":"3001563","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLOW CYTOMETRY 1ST SURF MARKER","code_information":[{"code":"3001564","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":378.0,"discounted_cash":226.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLOW CYTOMETRY 1ST SURF MARKER","code_information":[{"code":"3001565","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":378.0,"discounted_cash":226.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 4; JAKXB","code_information":[{"code":"3001566","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1676.0,"discounted_cash":1005.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1577.0,"discounted_cash":946.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 4","code_information":[{"code":"3001567","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1876.0,"discounted_cash":1125.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1770.0,"discounted_cash":1062.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PH,BODY FLUID,EXCEPT BLOOD","code_information":[{"code":"3001568","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FLUORESCENT ANTIBODY, SCREEN NMDCS","code_information":[{"code":"3001569","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1867.0,"discounted_cash":1120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1756.0,"discounted_cash":1053.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC STAPH AUREUS, AMPLIFIED PROBE TECH","code_information":[{"code":"3001570","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":211.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":270.0,"discounted_cash":162.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC STREP A, DNA, AMPLIFIED PROBE","code_information":[{"code":"3001571","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCREEN CLOZAPINE; CLZ","code_information":[{"code":"3001574","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN GABAPENTIN; GABA","code_information":[{"code":"3001576","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN LAMOTRIGINE LAMO","code_information":[{"code":"3001577","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN LEVETIRACETAM LEVE","code_information":[{"code":"3001578","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN MYCOPHENOLATE MPA","code_information":[{"code":"3001579","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN OXCARBAZEPINE OMHC","code_information":[{"code":"3001580","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN ZONISAMIDE ZONI","code_information":[{"code":"3001582","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":280.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MGMT GENE METHYLATION ANALYSIS MGMT","code_information":[{"code":"3001583","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81287","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":1069.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1731.0,"discounted_cash":1038.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INFECTIOUS AGNT DETECT BY DNA OR RNA; TRICHOMONAS VAGINALIS, AMPLFD PROBE TECHNQ","code_information":[{"code":"3001586","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HEMOGLOBIN-OXYGEN AFFINITY","code_information":[{"code":"3001591","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82820","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":495.0,"discounted_cash":297.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001592","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC ANTIPHOSPHATYDLSERINE","code_information":[{"code":"3001593","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":186.0,"discounted_cash":111.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001594","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, OTHER THAN INF AGENT AB/AG, QUANT BY RIA","code_information":[{"code":"3001595","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":5705.0,"discounted_cash":3423.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5222.0,"discounted_cash":3133.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001596","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":114.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001597","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2561.0,"discounted_cash":1536.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2344.0,"discounted_cash":1406.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLUORESCENT ANTIBODY, TITER","code_information":[{"code":"3001598","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":487.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":745.0,"discounted_cash":447.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; BORRELIA BURGDORFERI","code_information":[{"code":"3001599","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":280.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; BORRELIA BURGDORFERI","code_information":[{"code":"3001600","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":280.0,"discounted_cash":168.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC FLUORESCENT ANTIBODY, SCREEN","code_information":[{"code":"3001601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":487.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":745.0,"discounted_cash":447.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VITAMIN D; 25 HYDROXY; 25HDN","code_information":[{"code":"3001602","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":250.0,"discounted_cash":150.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREEN, QUANTITATIVE, AMPHETAMINES; 1 OR 2","code_information":[{"code":"3001608","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":276.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":419.0,"discounted_cash":251.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN, QUANT, ANABOL STEROID 1 OR 2; DHTS","code_information":[{"code":"3001609","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80327","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":159.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":250.0,"discounted_cash":150.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIDEPRESSANTS, TRICYCLIC AND OTHER CYCLICALS; 1 NOTRP","code_information":[{"code":"3001610","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":199.0,"discounted_cash":119.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIEPILEPTICS, NOT OTHER SPECIFIED; 1-3","code_information":[{"code":"3001611","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, BARBITURATES","code_information":[{"code":"3001612","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRUG SCREENING, BENZODIAZEPINES; 1-12","code_information":[{"code":"3001613","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, OPIATES, 1 OR MORE/OPATU","code_information":[{"code":"3001615","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":384.0,"discounted_cash":230.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, OXYCODONE/OPATU","code_information":[{"code":"3001616","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, PROPOXYPHENE FPPMC","code_information":[{"code":"3001617","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80367","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIDEPRESSANTS, TRICYCLIC AND OTHER CYCLICALS; 2 AMTRP","code_information":[{"code":"3001627","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":138.0,"discounted_cash":82.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, BENZODIAZEPINES; 1-12","code_information":[{"code":"3001629","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NON-INTERFACED, BIOTINIDASE,EACH, NEONATAL SCREENING","code_information":[{"code":"3001630","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82261","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, ASSAY OF PROGESTERONE, NEONATAL SCREENING","code_information":[{"code":"3001631","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, ASSAY THYROID STIM HORMONE, NEONATAL SCREENING","code_information":[{"code":"3001632","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NON-INTERFACED, CYSTIC FIBROSIS, NEONATAL SCREENING","code_information":[{"code":"3001633","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, HEMOGLOBIN CHROMATOGRAPHY, NEONATAL SCREENING","code_information":[{"code":"3001634","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, UNLSTD MOLECULAR PATHOLOGY PRCD, NEO SCREEN","code_information":[{"code":"3001636","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, GALACTOSE TRANSFERASE TEST, NEONATAL SCREENING","code_information":[{"code":"3001637","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82776","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCREENING, BENZODIAZEPINES; 1-12 BENZU","code_information":[{"code":"3001639","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":309.0,"discounted_cash":185.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, METHADONE MDTDU","code_information":[{"code":"3001640","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, METHADONE MDNS","code_information":[{"code":"3001641","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, BUPRENORPHINE BUPM","code_information":[{"code":"3001642","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, OPIATES, 1 OR MORE","code_information":[{"code":"3001643","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, BENZODIAZEPINES; 1-12","code_information":[{"code":"3001644","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, METHADONE","code_information":[{"code":"3001645","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, BARBITURATES BARBU","code_information":[{"code":"3001646","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AMPHETAMINES CONFIRMATION URINE AMPHU","code_information":[{"code":"3001648","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC VALPROIC ACID, TOTAL","code_information":[{"code":"3001649","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC VALPROIC ACID, FREE","code_information":[{"code":"3001650","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":187.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  HPV, HIGH RISK TYPES LAB TEST","code_information":[{"code":"3001651","type":"CDM"},{"code":"0311","type":"RC"},{"code":"G0476","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":169.0,"discounted_cash":101.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DIGOXIN; TOTAL","code_information":[{"code":"3001652","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREEN, QUANTITATIVE, ALCOHOLS, METHANOL","code_information":[{"code":"3001662","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":357.0,"discounted_cash":214.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREEN, QUANTITATIVE, AMPHETAMINES 1 OR 2","code_information":[{"code":"3001663","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, COCAINE","code_information":[{"code":"3001664","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":305.0,"discounted_cash":183.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC VALPROIC ACID, TOTAL","code_information":[{"code":"3001666","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":313.0,"discounted_cash":187.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, OPIATES, 1 OR MORE","code_information":[{"code":"3001668","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.0,"discounted_cash":166.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, OXYCODONE","code_information":[{"code":"3001669","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":212.0,"discounted_cash":127.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, FENTANYL","code_information":[{"code":"3001670","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":288.0,"discounted_cash":172.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY OF SOMATOSTATIN","code_information":[{"code":"3001674","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.0,"discounted_cash":773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; BORDETELLA","code_information":[{"code":"3001675","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANTIBODY; BORDETELLA","code_information":[{"code":"3001676","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ALKALOIDS, NOT OTHERWISE SPECIFIED, NICOS","code_information":[{"code":"3001677","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO GANGLIOSIDE ANTI IGG-IGM FGAGM","code_information":[{"code":"3001679","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":222.0,"discounted_cash":133.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IN SITU HYBRIDIZATION, PER SPEC; EA ADDL SINGLE PROBE STAIN PROC","code_information":[{"code":"3001680","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":634.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1110.0,"discounted_cash":666.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREEN, QUANTITATIVE, ALCOHOLS","code_information":[{"code":"3001683","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":357.0,"discounted_cash":214.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREEN, QUANTITATIVE, AMPHETAMINES; 1 OR 2","code_information":[{"code":"3001684","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING, COCAINE","code_information":[{"code":"3001685","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING, FENTANYL FENTU","code_information":[{"code":"3001686","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":188.0,"discounted_cash":112.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 2","code_information":[{"code":"3001688","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.0,"discounted_cash":1121.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1468.0,"discounted_cash":880.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, INF AGENT AB NOS","code_information":[{"code":"3001689","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":331.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":505.0,"discounted_cash":303.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO 83018 HEAVY METAL, QUANTIFICATION, EA; UIOD","code_information":[{"code":"3001690","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":364.0,"discounted_cash":218.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001691","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001692","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY","code_information":[{"code":"3001693","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":5553.0,"discounted_cash":3331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5079.0,"discounted_cash":3047.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO GANGLIOSIDE ANTI IGG-IGM ADDTL FGAGM","code_information":[{"code":"3001694","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":210.0,"discounted_cash":126.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2","code_information":[{"code":"3001695","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS","code_information":[{"code":"3001696","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":292.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":472.0,"discounted_cash":283.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN COCAINE COKEU","code_information":[{"code":"3001698","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":571.0,"discounted_cash":342.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS, ASL LAB, ALABS","code_information":[{"code":"3001699","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS, ASL LAB, ALABS","code_information":[{"code":"3001700","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO MUSCLE SPECIFIC KINASE AB SERUM MUSK","code_information":[{"code":"3001701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":2581.0,"discounted_cash":1548.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2482.0,"discounted_cash":1489.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FRTUP ASSAY OF THROXINE TOTAL; FRTUP","code_information":[{"code":"3001702","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":157.0,"discounted_cash":94.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO THYROGLOBULIN ANTIBODY, HTG2","code_information":[{"code":"3001703","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL","code_information":[{"code":"3001704","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":106.0,"discounted_cash":63.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IAAD EIA HISTOPLASM CAPULATUM UHIST","code_information":[{"code":"3001705","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY","code_information":[{"code":"3001706","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":99.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 HAD","code_information":[{"code":"3001707","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":772.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1246.0,"discounted_cash":747.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY INFECTIOUS AGT ANTIBODY QUAN NOS  HBABT","code_information":[{"code":"3001708","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":481.0,"discounted_cash":288.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG SCREENING OPIODS & OPIATE ANALOGS 5/MORE","code_information":[{"code":"3001709","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":481.0,"discounted_cash":288.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLUORESCENT NONNFCT AGT ANTB SCREEN-EA ANTB","code_information":[{"code":"3001710","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID OAP","code_information":[{"code":"3001711","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":42.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ALKALOIDS, NOT OTHERWISE SPECIFIED","code_information":[{"code":"3001712","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY APOLIPOPROTEIN A1 APABR","code_information":[{"code":"3001714","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":444.0,"discounted_cash":266.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY APOLIPOPROTEIN B,P APABR","code_information":[{"code":"3001715","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":444.0,"discounted_cash":266.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC UNLISTED CHEMISTRY PROCEDURE, STOOL OSMO","code_information":[{"code":"3001716","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":311.0,"discounted_cash":186.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED CHEMISTRY PROCEDURE, BF POTASSIUM","code_information":[{"code":"3001717","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":241.0,"discounted_cash":144.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREENING BENZODIAZEPINE FBZCN","code_information":[{"code":"3001721","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":197.0,"discounted_cash":118.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001742","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2316.0,"discounted_cash":1389.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2248.0,"discounted_cash":1348.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTI STEP FACT","code_information":[{"code":"3001744","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":529.0,"discounted_cash":317.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN METHYLPHENIDATE METUR","code_information":[{"code":"3001745","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":534.0,"discounted_cash":320.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN BENZODIAZEPINE (CLONAZEPAM) CZPS","code_information":[{"code":"3001746","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":128.0,"discounted_cash":76.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN BENZODIAZEPINE (LORAZEPAM)","code_information":[{"code":"3001747","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FACTOR INHIBITOR TEST SCREEN ADMIS","code_information":[{"code":"3001748","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":823.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1332.0,"discounted_cash":799.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FACTOR INHIBITOR TEST ADMBU","code_information":[{"code":"3001749","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1372.0,"discounted_cash":823.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1332.0,"discounted_cash":799.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PED PROF CORTISOL TOTAL","code_information":[{"code":"3001750","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PED PROF DESOXYCORTICOSTERONE 11","code_information":[{"code":"3001751","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":383.0,"discounted_cash":229.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PED PROF ASSAY OF PROGESTERONE","code_information":[{"code":"3001752","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":259.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PED PROF ASSAY OF TESTOSTERONE TOTAL","code_information":[{"code":"3001753","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SNRPN/UBE3A METHYLATION ANALYSIS PWAS","code_information":[{"code":"3001754","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81331","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.0,"discounted_cash":1208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1955.0,"discounted_cash":1173.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PNEUM IGG AB 23 INITIAL, PN23","code_information":[{"code":"3001755","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":39.0,"discounted_cash":23.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN PHENOBARBITAL QUANT PRMB","code_information":[{"code":"3001756","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":54.0,"discounted_cash":32.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN PRIMIDONE QUANT PRMB","code_information":[{"code":"3001757","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":76.0,"discounted_cash":45.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO QUANTITATION DRUG NOT ELSEWHERE SPEC CARBG","code_information":[{"code":"3001758","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG ASSAY CARBAMAZEPINE TOTAL CARBG","code_information":[{"code":"3001759","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":130.0,"discounted_cash":78.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL VALPG","code_information":[{"code":"3001760","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":106.0,"discounted_cash":63.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE VALPG","code_information":[{"code":"3001761","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":106.0,"discounted_cash":63.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY ANALYTE QUANT NOS  THYRO","code_information":[{"code":"3001762","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF MAGNESIUM FMAGR","code_information":[{"code":"3001763","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VLCAD DEFICIENCY FULL GENE, VLCZ","code_information":[{"code":"3001764","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":5475.0,"discounted_cash":3285.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5313.0,"discounted_cash":3187.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CHROMOSOMAL MICROARRAY, BLOOD, CMACB","code_information":[{"code":"3001765","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":6534.0,"discounted_cash":3920.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":6344.0,"discounted_cash":3806.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FABRY DIS FULL GENE ANAL, FABRZ","code_information":[{"code":"3001766","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3872.0,"discounted_cash":2323.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3757.0,"discounted_cash":2254.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HFE GENE ANALYSIS, HFE","code_information":[{"code":"3001767","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":665.0,"discounted_cash":399.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC KRAS MUTATION COLORECTRAL, KRASC","code_information":[{"code":"3001768","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.0,"discounted_cash":951.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1539.0,"discounted_cash":923.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SLIDE REVIEW, SLIRV","code_information":[{"code":"3001769","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":164.0,"discounted_cash":98.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INSULIN TOTAL, INSFT","code_information":[{"code":"3001771","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO INSULIN FREE, INSFT","code_information":[{"code":"3001772","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":107.0,"discounted_cash":64.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PLASMA CELL PRO, 1ST MARKER BM, PCPRO","code_information":[{"code":"3001773","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88182","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PLASMA CELL PRO FIRST SURFACE MARKER, BM, PCPRO","code_information":[{"code":"3001774","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV1 GENO PR-RT RESIST, HIVPR","code_information":[{"code":"3001775","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1884.0,"discounted_cash":1130.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1770.0,"discounted_cash":1062.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FIBROBLAST CULT GENETIC, TISSUE CULFB","code_information":[{"code":"3001776","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":1609.0,"discounted_cash":965.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBROBLAST CULT CELL CRYOPRESERVE CULFB","code_information":[{"code":"3001777","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMNIOTIC FL CULT GENETIC TEST, CULAF","code_information":[{"code":"3001778","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2362.0,"discounted_cash":1417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2292.0,"discounted_cash":1375.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AMNIOTIC FL CULT, CRYOPRESERVE, CULAF","code_information":[{"code":"3001779","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":157.0,"discounted_cash":94.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MATERNAL CELL CONT, MATCC","code_information":[{"code":"3001780","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1449.0,"discounted_cash":869.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1408.0,"discounted_cash":844.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COMP ANALYSIS STR, STR1","code_information":[{"code":"3001781","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":1044.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1692.0,"discounted_cash":1015.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COMP ANALYSIS STR, STR2","code_information":[{"code":"3001782","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81266","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":465.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":752.0,"discounted_cash":451.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HISTOPLASMA AB, SHSTO","code_information":[{"code":"3001783","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SOADENOVIRUS PCR, LCADP","code_information":[{"code":"3001784","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO  LEGIONELLA PCR, LEGRP","code_information":[{"code":"3001785","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":263.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":424.0,"discounted_cash":254.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PARVOVIRUS B19 PCR, PARVP","code_information":[{"code":"3001786","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":406.0,"discounted_cash":243.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO VARICELLA-ZOSTER VIRUS PCR, LVZV","code_information":[{"code":"3001787","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":406.0,"discounted_cash":243.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BODY FLUID, POTASSIUM (K), UNLISTED BFK","code_information":[{"code":"3001788","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":241.0,"discounted_cash":144.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NORTRIPTYLINE, NOTRP","code_information":[{"code":"3001799","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":166.0,"discounted_cash":99.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AMITRIPTYLINE AND NORTRIPTYLINE, AMTRP","code_information":[{"code":"3001800","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":138.0,"discounted_cash":82.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO APOLIPOPROTEIN A1 & B,P APLAB","code_information":[{"code":"3001801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":444.0,"discounted_cash":266.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS","code_information":[{"code":"3001802","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":417.0,"discounted_cash":250.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO TESTOSTERONE, TOTAL ONLY PEDS TTST","code_information":[{"code":"3001803","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TYSABRI/NATALIZUMAB IMMUNOGEN FSABI","code_information":[{"code":"3001804","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":743.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1202.0,"discounted_cash":721.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IADNA NOS AMPL PROBE EA ORG MHOMI MHRP","code_information":[{"code":"3001806","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":1577.0,"discounted_cash":946.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1531.0,"discounted_cash":918.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO UREAPLASMA MOLECULAR DETECT URRP EA","code_information":[{"code":"3001807","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UREAPLASMA MOLECULAR DETECT URRP ADTL","code_information":[{"code":"3001808","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CFTR GENE ANLYS CMMN VARIANTS CFP","code_information":[{"code":"3001809","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.0,"discounted_cash":450.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":729.0,"discounted_cash":437.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO RUFINAMIDE SERUM RUFI","code_information":[{"code":"3001810","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":141.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY NEPHELOMETRY EA ANLYT NES FHIB","code_information":[{"code":"3001811","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":217.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":352.0,"discounted_cash":211.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY HAPTOGLOBIN QUANT FHIB","code_information":[{"code":"3001812","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":327.0,"discounted_cash":196.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY APOLIPROTEIN EA FHIB","code_information":[{"code":"3001813","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":361.0,"discounted_cash":216.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ASSAY GLUTAMYLTRASE GAMMA FHIB","code_information":[{"code":"3001814","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BILIRUBIN TOTAL FHIB","code_information":[{"code":"3001815","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TRANSFERASE ALANINE AMINO ALT SGPT FHIB","code_information":[{"code":"3001816","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRG SCRN OPIOIDS/OPIATE ANLGS 5+ ARUP FOPIA","code_information":[{"code":"3001817","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":297.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":481.0,"discounted_cash":288.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY ANLYT QUANT NOS FPFIB","code_information":[{"code":"3001818","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":534.0,"discounted_cash":320.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOASSAY ANLYT QUANT NOS FPFIB ADTL","code_information":[{"code":"3001819","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":534.0,"discounted_cash":320.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC PROMETHEUS FIBROS FPFIP","code_information":[{"code":"3001820","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":558.0,"discounted_cash":334.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF APOLIPROTEIN FLFFT","code_information":[{"code":"3001822","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":374.0,"discounted_cash":224.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO BILIRUBIN TOTAL FLFFT","code_information":[{"code":"3001823","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF GLUTAMYLTRASE GAMMA FLFFT","code_information":[{"code":"3001824","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF HAPTOGLOBIN QUANT FLFFT","code_information":[{"code":"3001825","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":338.0,"discounted_cash":202.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF NEPHELOMETRY EA ANALYTE NES FLFFT","code_information":[{"code":"3001826","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TRANSFERASE ALANINE AMINO ALT SGPT FLFFT","code_information":[{"code":"3001827","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ALLERGEN SPEC IGG SPB","code_information":[{"code":"3001828","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE; SCREENING ONLY LAB4550","code_information":[{"code":"3001829","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCREENING CANNABINOIDS NATURAL THCU","code_information":[{"code":"3001830","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":187.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":302.0,"discounted_cash":181.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ISLET CELL ANTIBODY GAD65","code_information":[{"code":"3001831","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":122.0,"discounted_cash":73.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FLOURESCENT ANTIBODY SCREEN EA NMOCS","code_information":[{"code":"3001832","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":675.0,"discounted_cash":405.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY FOR PHENCYCLIDINE PCPU","code_information":[{"code":"3001833","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":375.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":608.0,"discounted_cash":364.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AMPHETAMINES 5 OR MORE FAMCO","code_information":[{"code":"3001834","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":241.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":390.0,"discounted_cash":234.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIEPILEPTICS NOS 1-3 FCLBZ","code_information":[{"code":"3001838","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":322.0,"discounted_cash":193.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS FPFIB","code_information":[{"code":"3001839","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":155.0,"discounted_cash":93.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS FPFIB","code_information":[{"code":"3001840","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":155.0,"discounted_cash":93.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ASSAY NEPHELOMETRY EA NOT SPEC FPFIB","code_information":[{"code":"3001841","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":165.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC CYP2C10 GENE COM VARIANTS LAB TEST","code_information":[{"code":"3001842","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1375.0,"discounted_cash":825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FMS RELATED TYROSINE KINASE 3 ITD VARIANTS FLT3 GENE","code_information":[{"code":"3001843","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.0,"discounted_cash":763.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1238.0,"discounted_cash":742.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FMS RELATED TYROSINE KINASE 3 TKD VARIANTS FLT3 GENE ANALYSIS","code_information":[{"code":"3001844","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.0,"discounted_cash":692.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1121.0,"discounted_cash":672.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CSF WEST NILE VIRUS AB WNV IGG","code_information":[{"code":"3001845","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CSF WEST NILE VIRUS AB WNV IGM","code_information":[{"code":"3001846","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WEST NILE VIRUS AB IGG","code_information":[{"code":"3001847","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO WEST NILE VIRUS AB IGM","code_information":[{"code":"3001848","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":68.0,"discounted_cash":40.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO LACTATE DEHYDROGENAS LDH","code_information":[{"code":"3001849","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":51.0,"discounted_cash":30.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ASSAY OF LDH ENZYMES SEP & QUANT","code_information":[{"code":"3001850","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO BILE ACIDS TOTAL BILEA","code_information":[{"code":"3001851","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PARIETAL CELL ANTIBODIES IGG SERUM PCAB","code_information":[{"code":"3001852","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":91.0,"discounted_cash":54.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HISTONE AUTOANTIBODIES SERUM HIS","code_information":[{"code":"3001853","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":80.0,"discounted_cash":48.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MVISTA BLASTOMYCES QUANT ANTIGEN FBLAS","code_information":[{"code":"3001854","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":513.0,"discounted_cash":307.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO FUNGITELL SERUM FUNGS","code_information":[{"code":"3001855","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":565.0,"discounted_cash":339.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MACROPROLACTIN SERUM D14 MCRPL","code_information":[{"code":"3001857","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":150.0,"discounted_cash":90.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MACROPROLACTIN SERUM D14 REPEAT MCRPL","code_information":[{"code":"3001858","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":150.0,"discounted_cash":90.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ACETYLCHOLINE RECEPTOR BINDING ANTIBODY ARBI","code_information":[{"code":"3001859","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MYASTHENIA GRAVIS/LAMBERT EATON SYN EVAL MGLES","code_information":[{"code":"3001860","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MYASTHENIA GRAVIS/LAMBERT EATON SYN REPEAT MGLES","code_information":[{"code":"3001861","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MYASTHENIA GRAVIS/LAMBERT EATON SYN MGLES","code_information":[{"code":"3001862","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PARANEOPLASTIC AUTOANTIBODY EVAL SERUM PAVAL","code_information":[{"code":"3001863","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":98.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PARANEOPLASTIC AUTOANTIBODY REPEAT SERUM PAVAL","code_information":[{"code":"3001864","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":98.0,"discounted_cash":58.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PARANEOPLASTIC AUTOANTIBODY SERUM PAVAL","code_information":[{"code":"3001865","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PARANEOPLASTIC AUTOANTIBODY EVAL SERUM PAVAL","code_information":[{"code":"3001866","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PARANEOPLASTIC AUTOANTIBODY REPEAT SERUM PAVAL","code_information":[{"code":"3001867","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MYASTHENIA GRAVIS EVAL THYMOMA MGETH","code_information":[{"code":"3001868","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":363.0,"discounted_cash":217.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MYASTHENIA GRAVIS EVAL THYMOMA REPEAT MGETH","code_information":[{"code":"3001869","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":363.0,"discounted_cash":217.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MYASTHENIA GRAVIS EVAL THYMOMA MGETH","code_information":[{"code":"3001870","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":349.0,"discounted_cash":209.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ISLET CELL ANTIBODY MGETH","code_information":[{"code":"3001871","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":534.0,"discounted_cash":320.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CRMP-5-IGG WESTERN BLOT MGETH","code_information":[{"code":"3001872","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":484.0,"discounted_cash":290.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NEURON SPECIFIC ENOLASE SERUM NSE","code_information":[{"code":"3001873","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IBD SEROLOGY PANEL SERUM IBDP","code_information":[{"code":"3001874","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":55.0,"discounted_cash":33.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IBD FUNGUS NES ANTIBODY IBDP","code_information":[{"code":"3001875","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":56.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IBD FUNGUS NES ANTIBODY REPEAT IBDP","code_information":[{"code":"3001876","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":56.0,"discounted_cash":33.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO TRYPTASE SERUM TRYPT","code_information":[{"code":"3001877","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":182.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SACCHAROMYCES CEREVISIAE ANTI IGA SERUM AASCA","code_information":[{"code":"3001878","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":90.0,"discounted_cash":54.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SACCHAROMYCES CEREVISIAE ANTI IGG SERUM GASCA","code_information":[{"code":"3001879","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":90.0,"discounted_cash":54.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IGFB PROTEIN 3 SERUM IGFB3","code_information":[{"code":"3001880","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":87.0,"discounted_cash":52.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SODIUM 24 HR URINE NAU SAT24","code_information":[{"code":"3001881","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":31.0,"discounted_cash":18.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO POTASSIUM 24 HR URINE KUR SAT24","code_information":[{"code":"3001882","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":29.0,"discounted_cash":17.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CHLORIDE 24 HR URINE CLU SAT24","code_information":[{"code":"3001883","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":20.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":33.0,"discounted_cash":19.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PHOSPHORUS 24 HR URINE POU SAT24","code_information":[{"code":"3001884","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":23.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":34.0,"discounted_cash":20.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO SULFATE 24 HR URINE SULFU SAT24","code_information":[{"code":"3001885","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":31.0,"discounted_cash":18.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CITRATE EXCRETION 24 HR URINE CITR SAT24","code_information":[{"code":"3001886","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":165.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO OXALATE 24 HR URINE OXU SAT24","code_information":[{"code":"3001887","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PH 24 HR URINE PHU_ SAT24","code_information":[{"code":"3001888","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":24.0,"discounted_cash":14.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO URIC ACID 24 HR URINE URCU SAT24","code_information":[{"code":"3001889","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":31.0,"discounted_cash":18.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CREATININE 24 HR URINE CTU SAT24","code_information":[{"code":"3001890","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":87.0,"discounted_cash":52.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO OSMOLALITY 24 HR URINE UOSMU SAT24","code_information":[{"code":"3001891","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":44.0,"discounted_cash":26.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CALCIUM 24 HR URINE CALU SAT24","code_information":[{"code":"3001892","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":25.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":42.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MAGNESIUM 24HR URINE MAGU SAT24","code_information":[{"code":"3001893","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":45.0,"discounted_cash":27.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO AMMONIA 24HR URINE AMMO SAT24","code_information":[{"code":"3001894","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":95.0,"discounted_cash":57.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO UREA 24HR URINE URAU SAT24","code_information":[{"code":"3001895","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":31.0,"discounted_cash":18.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTI-GLIADIN IGA PRO GLID IGA","code_information":[{"code":"3001896","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTI-GLIADIN IGG PRO GLID IGG","code_information":[{"code":"3001897","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TISSUE TRANSGLUTAMINASE ANTI IGA PRO TTIGA","code_information":[{"code":"3001898","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":155.0,"discounted_cash":93.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TOTAL SERUM IGA PRO TOT IGA","code_information":[{"code":"3001900","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":89.0,"discounted_cash":53.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO HLA-DQA1 HIGH RESOLUTION PRO HLADQA1","code_information":[{"code":"3001901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1117.0,"discounted_cash":670.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HEP A ANTIBDY  IGM  LAB TEST","code_information":[{"code":"3001904","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":448.0,"discounted_cash":268.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN, FPMET","code_information":[{"code":"3001906","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1279.0,"discounted_cash":767.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN, FMITO","code_information":[{"code":"3001907","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":360.0,"discounted_cash":216.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN, VIGA","code_information":[{"code":"3001908","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.0,"discounted_cash":259.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":419.0,"discounted_cash":251.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN Q10","code_information":[{"code":"3001909","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":463.0,"discounted_cash":277.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN, SLO","code_information":[{"code":"3001910","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN, FAPEP","code_information":[{"code":"3001911","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":565.0,"discounted_cash":339.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN, ACYLG","code_information":[{"code":"3001912","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":316.0,"discounted_cash":189.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOFLUOR ANTB 1ST STAIN, FAEAB","code_information":[{"code":"3001913","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":744.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1053.0,"discounted_cash":631.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO IMMUNOFLUOR ANTB ADDTL STAIN, FAEAB","code_information":[{"code":"3001914","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1053.0,"discounted_cash":631.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN BAFS","code_information":[{"code":"3001915","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":559.0,"discounted_cash":335.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO COL CHROMATOGRAPHY QUANT MPSSC","code_information":[{"code":"3001916","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":228.0,"discounted_cash":136.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MUCOPOLYSACC ACID QUAL MPSSC","code_information":[{"code":"3001917","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO MOLECULAR PATH PROC LVL 4 CEBPA","code_information":[{"code":"3001918","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81218","type":"HCPCS"}],"standard_charges":[{"gross_charge":1467.0,"discounted_cash":880.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1423.0,"discounted_cash":853.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO CALRETICULIN GENE ANLYS CMMN VAR EXON 9 CALR","code_information":[{"code":"3001919","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":2316.0,"discounted_cash":1389.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2248.0,"discounted_cash":1348.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO C1 ESTERASE INHIBITOR ANTIGEN SERUM C1ES","code_information":[{"code":"3001926","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLOMERULAR BASEMENT MEMBRANE ANTIB IGG SERUM GBM","code_information":[{"code":"3001927","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO C1 ESTERASE INHIBITOR FUNC ASSAY SERUM FC1EQ","code_information":[{"code":"3001928","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBDY TITER, REFLEX GABIS","code_information":[{"code":"3001929","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":440.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCRNING OXYCODONE, REFLEX OXYCU","code_information":[{"code":"3001930","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":355.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALKALOIDS NOS, NICOU","code_information":[{"code":"3001932","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IAAD IA HISTOPLSM CAPSUL AG IA, FHST","code_information":[{"code":"3001933","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT NONINFCT AGT ANTB SCREEN, IBDP","code_information":[{"code":"3001934","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY FUNGUS NES, IBDP","code_information":[{"code":"3001935","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY FUNGUS NES REPEAT, IBDP","code_information":[{"code":"3001936","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO GONADOTROPIN FOLLICLE STIM HRMN, FSHPED","code_information":[{"code":"3001937","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF ESTRADIOL, EEST","code_information":[{"code":"3001938","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF GONADOTROPIN LH, LHPED","code_information":[{"code":"3001939","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":402.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PARANEOPLASTIC AUTOANTIBODY EVAL PAVAL","code_information":[{"code":"3001940","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PARANEOPLASTIC AUTOANTIBODY EVAL PAVAL","code_information":[{"code":"3001941","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FLUORESCENT ANTIBODY INTL, PAVAL, MSAES","code_information":[{"code":"3001942","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY ADDL, PAVAL, MSAES","code_information":[{"code":"3001943","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO STRIATIONAL ANTIBODIES PAVAL","code_information":[{"code":"3001944","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":56.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MG EVAL THYMOMA MGT1","code_information":[{"code":"3001945","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":227.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MG EVAL THYMOMA MGT1","code_information":[{"code":"3001946","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":227.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MG EVAL STRIATED MUSCLE AB MGT1","code_information":[{"code":"3001947","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MG EVAL GAD65 AB MGT1","code_information":[{"code":"3001948","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MG EVAL CRMP-5-IGG WEST BLOT MGT1","code_information":[{"code":"3001949","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MYASTHENIA GRAVIS/LAMBERT-EATON SYNDRM, MGL1","code_information":[{"code":"3001950","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MYASTHENIA GRAVIS/LAMBERT-EATON SYNDRM ADDL, MGL1","code_information":[{"code":"3001951","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO STRIATIONAL ANTIBODIES, MGL1","code_information":[{"code":"3001952","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELET INHIBITION ASSAY","code_information":[{"code":"3001953","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":996.0,"discounted_cash":597.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TESTOSTERONE FREE FRTST/TTFB","code_information":[{"code":"3001954","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO KIDNEY STONE ANALYSIS CASA","code_information":[{"code":"3001956","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOGLOBULIN TOTAL LIGHT CHAINS LAMB/TLCU","code_information":[{"code":"3001957","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO IGA SUBCLASSES IGA/IGAS","code_information":[{"code":"3001958","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGA SUBCLASSES IGA1/IGAS","code_information":[{"code":"3001959","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGA SUBCLASSES IGA2/IGAS","code_information":[{"code":"3001960","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO ACHR BINDING ANTIBODY ACHBIN/ARBI","code_information":[{"code":"3001961","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MACROPROLACTIN TOTPROL/MCRPL","code_information":[{"code":"3001962","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MACROPROLACTIN UNPRECIP/MCRPL","code_information":[{"code":"3001963","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO PARIETAL CELL ANTIBODIES IGG PCAB","code_information":[{"code":"3001964","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTONE AUTOANTIBODIES HIS","code_information":[{"code":"3001965","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HBRP BLASTOAG/FBLAS","code_information":[{"code":"3001966","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FUNGITELL FUNGS","code_information":[{"code":"3001967","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TILAPIA IGE FFTIL","code_information":[{"code":"3001969","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HELICOBACTER PYLORI UREA BREATH TEST UBT","code_information":[{"code":"3001974","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV2 AB CONFIRMATION HIV2L","code_information":[{"code":"3001975","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOGLOBULIN D IGD","code_information":[{"code":"3001976","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CEREBROSPINAL FLUID  IGG IGGCSF/SFIN","code_information":[{"code":"3001983","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CEREBROSPINAL FLUID ADDTL  IGG IGGS/SFIN","code_information":[{"code":"3001984","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":27.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ALBUMIN SERUM ALBS/SFIN","code_information":[{"code":"3001985","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALBUMIN CSF ALBCSF/SFIN NON URINE","code_information":[{"code":"3001986","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MS PROFILE IGGS/MSP2","code_information":[{"code":"3001987","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MS PROFILE IGGCSF/MSP2","code_information":[{"code":"3001988","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MS ALBUMIN ALBS/MSP2","code_information":[{"code":"3001989","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":18.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MS ALBUMIN ALBCSF/MSP2 NON URINE","code_information":[{"code":"3001990","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MS OLIGOCLONAL BANDS BANDSS/MSP2","code_information":[{"code":"3001991","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MS OLIGOCLONAL BANDS BANDSCSF/MSP2","code_information":[{"code":"3001992","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO IGG4 SUBCLASSES IGGSUB/IGGS","code_information":[{"code":"3001993","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":18.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGG4 SUBCLASSES SUBADL/IGGS","code_information":[{"code":"3001994","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":18.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO IGG TOTAL IGG/IGGS","code_information":[{"code":"3001995","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":23.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEPHELOMETRY IGA SUBCLASSES IGG/IGAS","code_information":[{"code":"3002000","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEPHELOMETRY IGA SUBCLASSES IGGADDL/IGAS","code_information":[{"code":"3002001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO NEPHELOMETRY IGA/IGD/IGG/IGM G.GLOBULIN/IGAS","code_information":[{"code":"3002002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CELIAC DISEASE SEROLOGY IGA/CDSP","code_information":[{"code":"3002003","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CELIAC DIS COMP CASCADE HLAII/CDCOM","code_information":[{"code":"3002004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CELIAC DIS COMP CASCADE HLAIIADDL/CDCOM","code_information":[{"code":"3002005","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81376","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO CELIAC DIS COMP IGA/CDCOM","code_information":[{"code":"3002006","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WEST NILE VIRUS AB SERUM IGMAB/WNC","code_information":[{"code":"3002007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WEST NILE VIRUS AB SERUM IGGAB/WNC","code_information":[{"code":"3002008","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMIODARONE SERUM AMIO","code_information":[{"code":"3002009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FELBAMATE/FELBATOL SERUM FELBA","code_information":[{"code":"3002010","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BETA-HYDROXYBUTYRATE SERUM BHYD","code_information":[{"code":"3002011","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALPHA-1 ANTITRYPSIN ALPHA1/A1APP","code_information":[{"code":"3002012","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALPHA-1 ANTITRYPSIN PHENOTYPE A1PHENO/A1APP","code_information":[{"code":"3002013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SULFTIDE AUTOANTIBODY FSUAB","code_information":[{"code":"3002019","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":733.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SULFTIDE AUTOANTIBODY EA ADDTL, FSUAB","code_information":[{"code":"3002020","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":733.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO OLIGOCLONAL BANDING SERUM/OLIG","code_information":[{"code":"3002021","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OLIGOCLONAL BANDING CSF/OLIG","code_information":[{"code":"3002022","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO INFULENZA VIRUS B SERUM IGG/SFLB","code_information":[{"code":"3002024","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INFULENZA VIRUS B SERUM IGM/SFLB","code_information":[{"code":"3002025","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO LACOSAMIDE SERUM LACO","code_information":[{"code":"3002026","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMINO ACIDS QUAL UOI/AAS","code_information":[{"code":"3002027","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82128","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMINO ACIDS QUAL UOI/AAQTB","code_information":[{"code":"3002028","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82128","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMINO ACIDS QUANT PLASMA UOI/AAQTB","code_information":[{"code":"3002029","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":1679.0,"discounted_cash":1007.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMINO ACIDS QUANT URINE UOI/AAPD","code_information":[{"code":"3002030","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO APOLIPOPRTEIN B PLASMA APLB","code_information":[{"code":"3002031","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TISSUE TTG AB IGG SERUM/TTGG","code_information":[{"code":"3002036","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLIADIN DEAMIDATED AB IGA SERUM/DAGL","code_information":[{"code":"3002037","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLIADIN DEAMIDATED AB IGG SERUM/DGGL","code_information":[{"code":"3002038","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TISSUE TTG AB IGA SERUM/TTGA","code_information":[{"code":"3002039","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR MUSCLE MODULATING AB ARMO","code_information":[{"code":"3002040","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.0,"discounted_cash":773.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACHR GANGLIONIC NEURONAL AB GANG","code_information":[{"code":"3002041","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":702.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIMULLERIAN HORMONE SERUM AMH","code_information":[{"code":"3002042","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GANGLIOSIDE GQ1B AB IGG EIA FGQ1B","code_information":[{"code":"3002043","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":370.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MAG AB W/REFLX FMGS","code_information":[{"code":"3002044","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MAG AB W/REFLX ADDL/FMGS","code_information":[{"code":"3002045","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO MERCURY BLOOD HG","code_information":[{"code":"3002046","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO METANEPHRINES FRACT 24HR URINE METAF","code_information":[{"code":"3002047","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO METANEPHRINES FRACT FREE PLASMA PMET","code_information":[{"code":"3002048","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ORGANIC ACIDS UOI/ORASN","code_information":[{"code":"3002049","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ORGANIC ACIDS UOI/ORGAC","code_information":[{"code":"3002050","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, FATTY,ORGANIC,AMINO ACID DISORDERS, NEONATAL SCREEN","code_information":[{"code":"3002051","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC COAG TIME ACTIV TEG-R LAB TEST","code_information":[{"code":"3002052","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC FIBRINOGEN ACTIV TEG-ANGLE LAB TEST","code_information":[{"code":"3002053","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC PLATELET AGGREGATION TEG-MA LAB TEST","code_information":[{"code":"3002054","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CLOT FX ACT TEG-EPL/LY30 LAB TEST","code_information":[{"code":"3002055","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CLOT FX ACTVTY TEG-CI LAB TEST","code_information":[{"code":"3002056","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC TB CONCENTRATION","code_information":[{"code":"3002057","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CALPROTECTIN, FECAL CALPR","code_information":[{"code":"3002058","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OPIATES 1 OR MORE FOPIA","code_information":[{"code":"3002059","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OXYCODONE FOPIA","code_information":[{"code":"3002060","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC COAG TIME ACTIV  HEPARIN TEG-R LAB TEST","code_information":[{"code":"3002061","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SFMC FIBRINOGEN ACT HEP TEG-ANGLE LAB TEST","code_information":[{"code":"3002062","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SFMC PLATELET AGG HEPARIN TEG-MA LAB TEST","code_information":[{"code":"3002063","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC CLOT FX HEPARIN TEG-EPL/LY30 LAB TEST","code_information":[{"code":"3002064","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SFMC CLOT FX ACTV HEPARIN TEG-CI LAB TEST","code_information":[{"code":"3002065","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO IMMUNOASSAY, ANALYTE, QUANT, NOS,PROM IBD, AB INT","code_information":[{"code":"3002066","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY, ANALYTE, QUANT, NOS,PROM IBD, AB ADL","code_information":[{"code":"3002067","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CHEMILUMINESCENT ASSAY, PROM IBD ICAM, MSAES","code_information":[{"code":"3002068","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHEMILUMINESCENT ASSAY,PROM IBD VCAM","code_information":[{"code":"3002069","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CHEMILUMINESCENT ASSAY,PROM IBD SAA","code_information":[{"code":"3002070","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO C-RE1 PROTEIN,PROM IBD CRP","code_information":[{"code":"3002071","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UNLISTED MOLECULAR PATH,PROM IBD SNP INT","code_information":[{"code":"3002072","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UNLISTED MOLECULAR PATH,PROM IBD SNP ADL","code_information":[{"code":"3002073","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO COL CHROMATOGRAPHY QUAL/QUAN, VIGA","code_information":[{"code":"3002074","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMPHETAMINES QUANT 1OR2 AMPHU","code_information":[{"code":"3002075","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TYSABRI IMMUNOGENICITY FSABI","code_information":[{"code":"3002078","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":1502.0,"discounted_cash":901.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PH 24HR URINE MAYO UPH24","code_information":[{"code":"3002079","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC CUL AERO ADL","code_information":[{"code":"3002095","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BB AB EA RBC ELUTION","code_information":[{"code":"3002108","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BB AB RBC EA PANEL FOR EA SER TECH","code_information":[{"code":"3002109","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BB RBC AG OTHER THAN ABO RH, PATIENT","code_information":[{"code":"3002116","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BB PRETRE RBC AB DET, ID, COMP BY ENZ, EA","code_information":[{"code":"3002121","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CSF, HERPES SIMPLEX PCR LAB TEST","code_information":[{"code":"3002126","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CSF, HERPES SIMPLEX PCR ADL LAB TEST","code_information":[{"code":"3002127","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":279.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC HERPES SIMP VIR NON-CSF LAB TEST","code_information":[{"code":"3002128","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC HERPES SIMP VIR NON-CSF ADL LAB TEST","code_information":[{"code":"3002129","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":288.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CELL BOUND PLT AB BLOOD CBPAN","code_information":[{"code":"3002142","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PLT AB SERUM PLABN","code_information":[{"code":"3002143","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NMO AQP4 NMOFS","code_information":[{"code":"3002144","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NMO AQP4 TITER NMOTS","code_information":[{"code":"3002145","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO STRIATED MUSCLE AB STR","code_information":[{"code":"3002146","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOTTING FACTOR  X111 FF13F","code_information":[{"code":"3002147","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PROTEIN WEST BLOT WBN","code_information":[{"code":"3002148","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.0,"discounted_cash":371.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TESTOSTERONE TOTAL BIO FREE TTFB","code_information":[{"code":"3002149","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":31.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BORDETELLA PERTUSSIS AB, IGG, BORDG","code_information":[{"code":"3002153","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EVEROLIMUS, EVROL","code_information":[{"code":"3002156","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":884.0,"discounted_cash":530.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UR OVULATION DETECTION TEST (LH)","code_information":[{"code":"3002157","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84830","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REFLEX, HIV 1 CONF","code_information":[{"code":"3002158","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":235.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REFLEX, HIV 2 CONF","code_information":[{"code":"3002159","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROGESTERONE PGSN","code_information":[{"code":"3002160","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CREATININE, OTHER SOURCE, NTXPR, NMHR, 23BPR","code_information":[{"code":"3002161","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC BETA 2 GPI, IGG LAB TEST","code_information":[{"code":"3002162","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC BETA 2 GPI ANTIBDY ADDL LAB TEST","code_information":[{"code":"3002163","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC ENA ANTBDY ANY METHOD SRNP LAB TEST","code_information":[{"code":"3002164","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC IMMUNOASSAY MULTI STEP TTG IGG LAB TEST","code_information":[{"code":"3002165","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA AB CHROMATIN LAB TEST","code_information":[{"code":"3002166","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA  RIBS PROTEIN LAB TEST","code_information":[{"code":"3002167","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA AB  CENTBAB LAB TEST","code_information":[{"code":"3002168","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TREPONEMA PALLIDUM ANTBDY LAB TEST","code_information":[{"code":"3002169","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC GBM LAB TEST","code_information":[{"code":"3002170","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LIPOPROTEIN PLA2 PLACA","code_information":[{"code":"3002172","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LIPOPROTEIN HIGH DENSITY CHOL FNMR2","code_information":[{"code":"3002174","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":24.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRIGLYCERIDES; FNMR2","code_information":[{"code":"3002175","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":18.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO LIPOPROTEIN BLD QNT LDL PARTICLES FNMR2","code_information":[{"code":"3002176","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTI BARTONELLA B.HENSELAE IGM BART","code_information":[{"code":"3002177","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTI BARTONELLA B.QUINTANA IGM BART","code_information":[{"code":"3002178","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CHLAMYDIA C.PSITTACI IGG SCLAM","code_information":[{"code":"3002179","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":28.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO CHLAMYDIA C.PSITTACI IGM SCLAM","code_information":[{"code":"3002180","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":28.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO CREATININE URINE NTXPR","code_information":[{"code":"3002181","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYSTATIN CYSTC","code_information":[{"code":"3002182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC RUBELLA IGG LAB TEST","code_information":[{"code":"3002183","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC PR3 LAB TEST","code_information":[{"code":"3002184","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA ANTBDY ANY METHOD SSA LAB TEST","code_information":[{"code":"3002185","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA ANTBDY ANY METHOD SSB LAB TEST","code_information":[{"code":"3002186","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA ANTBDY ANY METHOD SMITH LAB TEST","code_information":[{"code":"3002187","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA ANTBDY ANY METHOD SCL7E LAB TEST","code_information":[{"code":"3002188","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ENA ANTBDY ANY METHOD JO1 LAB TEST","code_information":[{"code":"3002189","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC RUBELLA IGM LAB TEST","code_information":[{"code":"3002190","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC EBV AB HETEROPHILE LAB TEST","code_information":[{"code":"3002191","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC BETA 2 GPI, IGM LAB TEST","code_information":[{"code":"3002192","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC BETA 2 GPI, IGA LAB TEST","code_information":[{"code":"3002193","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,SALICYLATE LEVEL","code_information":[{"code":"3002197","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":284.0,"discounted_cash":170.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,ACETAMINOPHEN/TYLENOL","code_information":[{"code":"3002198","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":414.0,"discounted_cash":248.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE AMPHETAMINES,QUALITATIVE","code_information":[{"code":"3002199","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE DRUG SCREENING W/O CONFIRMATION","code_information":[{"code":"3002200","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1987.0,"discounted_cash":1192.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1817.0,"discounted_cash":1090.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE BARBITURATES,QUALITATIVE","code_information":[{"code":"3002202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE BENZODIAZEPINE,QUALITATIVE","code_information":[{"code":"3002203","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE CANNABINOID/THC","code_information":[{"code":"3002204","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE COCAINE METABOLYTES,QUALITATIVE","code_information":[{"code":"3002205","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE METHADONE","code_information":[{"code":"3002206","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE OPIATES","code_information":[{"code":"3002207","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE PHENCYCLIDINE/PCP","code_information":[{"code":"3002208","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE CONTININE/NICOTINE","code_information":[{"code":"3002209","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":271.0,"discounted_cash":162.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NON-INTERFACED, ETOH, MECONIUM","code_information":[{"code":"3002210","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":335.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, MECONIUM 7 TOXICOLOGY","code_information":[{"code":"3002211","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.0,"discounted_cash":891.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1359.0,"discounted_cash":815.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NON-INTERFACED, MECONIUM 5 TOXICOLOGY","code_information":[{"code":"3002212","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.0,"discounted_cash":637.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":971.0,"discounted_cash":582.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NON-INTERFACED, CORDSTAT 7 TOXICOLOGY","code_information":[{"code":"3002213","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.0,"discounted_cash":891.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1359.0,"discounted_cash":815.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NON-INTERFACED, CORDSTAT 5 TOXICOLOGY","code_information":[{"code":"3002214","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.0,"discounted_cash":637.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":971.0,"discounted_cash":582.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC CYRPT AG, QUAL, CSF LAB TEST","code_information":[{"code":"3002217","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC CYRPT AG, QUANT, CSF LAB TEST","code_information":[{"code":"3002218","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86406","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":260.0,"discounted_cash":156.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC CULT SCR, CIPRO RESIST  LAB TEST","code_information":[{"code":"3002219","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":115.0,"discounted_cash":69.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC CULT QT AEROBIC DUODENAL ASP LAB TEST","code_information":[{"code":"3002220","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ANAEROB CULT DUODENAL ASP LAB TEST","code_information":[{"code":"3002221","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87073","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ENA ANTBDY ANY METHOD RNPAB LAB TEST","code_information":[{"code":"3002222","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GLIADIN IGA LAB TEST","code_information":[{"code":"3002223","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":42.0,"discounted_cash":25.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC  HGB ELECTROPHORESIS, A2 LAB TEST","code_information":[{"code":"3002224","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":335.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HGB ELECTROPHORESIS, A2 & F LAB TEST","code_information":[{"code":"3002225","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":335.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC MYCOPLASMA IGM LAB TEST","code_information":[{"code":"3002226","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC VARICELLA-ZOSTER AB, IGM LAB TEST","code_information":[{"code":"3002227","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":316.0,"discounted_cash":189.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IGA LAB TEST","code_information":[{"code":"3002228","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC IGG LAB TEST","code_information":[{"code":"3002229","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH IGM LAB TEST","code_information":[{"code":"3002230","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO ANTIBODY, COXIELLA BRUNETTI IGM, QFP","code_information":[{"code":"3002231","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, COXIELLA BRUNETTI IGM ADDL, QFP","code_information":[{"code":"3002232","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PHOSPHORUS URINE, RPOU","code_information":[{"code":"3002233","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GENOTYPE DNA/RNA HIV, HIVI","code_information":[{"code":"3002234","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":1814.0,"discounted_cash":1088.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRUG SCREEN QUANT, BLD ALCOHOL, ETHANOL","code_information":[{"code":"3002237","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":392.0,"discounted_cash":235.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO DRUG ABUSE CONFIRM PANEL 9 CDAU7","code_information":[{"code":"3002238","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TESTOSTERONE BIOAVAIL TTFB","code_information":[{"code":"3002239","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":86.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO TESTOSTERONE TOTAL TTFB","code_information":[{"code":"3002240","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":65.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TESTOSTERONE FREE TTFB","code_information":[{"code":"3002241","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCREEN SCRIPT/OTC SERUM DSS","code_information":[{"code":"3002242","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PAIN 250 DRUG SCREEN URINE PCDSO","code_information":[{"code":"3002243","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":560.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OXYCODONE SCREEN URINE OXYSU","code_information":[{"code":"3002244","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCREEN SCRIPT/OTC URINE PDSU","code_information":[{"code":"3002245","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BUPRENORPHINE ANALYSIS URINE FBAU","code_information":[{"code":"3002246","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":379.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ALLERGEN SPECIF  IGE INIT LAB TEST","code_information":[{"code":"3002247","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC ALLERGEN SPECIFIC IGE ADDTL LAB TEST","code_information":[{"code":"3002248","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC IGE OVOMUCOID LAB TEST","code_information":[{"code":"3002249","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC IGE OVALBUMIN LAB TEST","code_information":[{"code":"3002250","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC LACTAL LAB TEST","code_information":[{"code":"3002251","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC BLACTO LAB TEST","code_information":[{"code":"3002252","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC IGE CASEIN LAB TEST","code_information":[{"code":"3002253","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC MYCOPLASMA IGG LAB TEST","code_information":[{"code":"3002254","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":223.0,"discounted_cash":133.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH  INF AG DET AMP PROBE LAB TEST","code_information":[{"code":"3002255","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC NON INTERFACED CYTOTOXIC AB SCREEN POST GOH/DSA","code_information":[{"code":"3002256","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1396.0,"discounted_cash":837.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NON-INTERFACED, CYTXIC AB SCRN POST GOH/DSA,ADTL","code_information":[{"code":"3002257","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1396.0,"discounted_cash":837.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO VITB6 PROFILE PLP AND PA PLASM QUANT, B6PRO","code_information":[{"code":"3002259","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":314.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VITB6 PYRIDOXAL PHOSPHATE B6PRO","code_information":[{"code":"3002260","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":490.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO N-TELOPEPTIDE CROSSLINKED SERUM FNTPX","code_information":[{"code":"3002261","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROCOLLAGEN I INTACT N-TERMINAL SERUM, PINP","code_information":[{"code":"3002262","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEPATITIS DELTA VIRUS AB ARUP FHEDA","code_information":[{"code":"3002263","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LEPTOSPIRA IGM LEPDT","code_information":[{"code":"3002266","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NT-PRO B TYPE NATRIURETIC PEPTIDE, PBNP","code_information":[{"code":"3002267","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THIOPURIN METHYLTRANSFERASE ACTIVITY PROFILE, TPMT3","code_information":[{"code":"3002268","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.0,"discounted_cash":829.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INHIBIN B, INHB","code_information":[{"code":"3002269","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC/DMH TESTESTERONE TOTA  FTTST LAB TEST","code_information":[{"code":"3002270","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":340.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":568.0,"discounted_cash":340.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC/DMH SEX HORM BIND GLOB FTTST LAB TEST","code_information":[{"code":"3002271","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":245.0,"discounted_cash":147.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ALBUMIN FTTST LAB TEST","code_information":[{"code":"3002272","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC REFLEX ENA PANEL - DSDNA LAB TEST","code_information":[{"code":"3002273","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":566.0,"discounted_cash":339.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC REFLEX ENA PANEL - CHROMAB LAB TEST","code_information":[{"code":"3002274","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA  PANEL - RIBOPAB LAB TEST","code_information":[{"code":"3002275","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - SSA LAB TEST","code_information":[{"code":"3002276","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - SSB LAB TEST","code_information":[{"code":"3002277","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - CENTBAB LAB TEST","code_information":[{"code":"3002278","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - SMITH LAB TEST","code_information":[{"code":"3002279","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - SRNP LAB TEST","code_information":[{"code":"3002280","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - RNPAB LAB TEST","code_information":[{"code":"3002281","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - SCL7E LAB TEST","code_information":[{"code":"3002282","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC REFLEX ENA PANEL - JO1 LAB TEST","code_information":[{"code":"3002283","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NEONATAL ALCOHOL EXPOSURE, USDTL LAB","code_information":[{"code":"3002285","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC IAAD  H PYLORI AG LAB TEST","code_information":[{"code":"3002286","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LYME DISEASE, MOLECULAR DETECT, PCR; PBORR","code_information":[{"code":"3002293","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LYME DISEASE, MOLECULAR DETECT, PCR, EA ADDTL; PBORR","code_information":[{"code":"3002294","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO DRUG SCREEN BUPRENORPHINE; BUPM","code_information":[{"code":"3002295","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SRN PRSMV CHEM ANALYZR; BUPR","code_information":[{"code":"3002296","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC MICROBE SUSCEPTIBLE MIC","code_information":[{"code":"3002322","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC CREATININE OTHR SOURCE","code_information":[{"code":"3002359","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC VOLATILES","code_information":[{"code":"3002367","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WEST NILE VIRUS AB IGM FWTNL","code_information":[{"code":"3002387","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WEST NILE VIRUS FWTNL","code_information":[{"code":"3002388","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.0,"discounted_cash":325.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNO QUANT NOS NON AB TS-HDS","code_information":[{"code":"3002389","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNO QUANT NOS NON AB EA ADDTL TS-HDS","code_information":[{"code":"3002390","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":196.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CARNITINE CARN","code_information":[{"code":"3002391","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CARNITINE URINE CARN","code_information":[{"code":"3002392","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC HGB CHROMATOGRAPHY A2 & F LAB TEST","code_information":[{"code":"3002393","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DESOXYCORTICOSTERONE, FFCAH","code_information":[{"code":"3002394","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DEOXYCORTISOL, FFCAH","code_information":[{"code":"3002395","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF ANDROSTENEDIONE, FFCAH","code_information":[{"code":"3002396","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TOTAL CORTISOL, FFCAH","code_information":[{"code":"3002397","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DEHYDROEPIANDROSTERONE, FFCAH","code_information":[{"code":"3002398","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF 17-HYDROXYPREGNENO, FFCAH","code_information":[{"code":"3002399","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF PROGESTERONE, FFCAH","code_information":[{"code":"3002400","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HYDROXYPROGESTERONE 17-D, FFCAH","code_information":[{"code":"3002401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TESTOSTERONE TOTAL, FFCAH","code_information":[{"code":"3002402","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":201.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LYSOSOMAL PEROXISOMAL STORAGE DISORDER PLSD","code_information":[{"code":"3002403","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX MUCOPOLYSACCHARIDOSIS, MPSBS","code_information":[{"code":"3002404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PSYCHOSINE, PSY","code_information":[{"code":"3002405","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":644.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO REFLEX GLUCOPSYCHOSINE, GPSY","code_information":[{"code":"3002406","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1074.0,"discounted_cash":644.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO REFLEX OXYSTEROLS, OXYBS","code_information":[{"code":"3002407","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO REFLEX LYSOPC BY LC MS/MS, LPCBS","code_information":[{"code":"3002408","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO NEURONAL (V-G) K+ CHANNEL AB, S, DMS1","code_information":[{"code":"3002409","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR (MUSCLE) BINDING AB, DMS1","code_information":[{"code":"3002410","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO N-TYPE CALCIUM CHANNEL AB, DMS1","code_information":[{"code":"3002411","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO P/Q-TYPE CALCIUM CHANNEL AB, DMS1","code_information":[{"code":"3002412","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ACHR GANGLIONIC NEURONAL AB, S, DMS1","code_information":[{"code":"3002413","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GAD65 ANTIBODY ASSAY, DMS1","code_information":[{"code":"3002414","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":198.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMC AB TYPE TR, DMS1","code_information":[{"code":"3002415","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CRMP-5-IGG, S, DMS1","code_information":[{"code":"3002416","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL AB, TYPE 3, DMS1","code_information":[{"code":"3002417","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMIC AB TYPE 2, DMS1","code_information":[{"code":"3002418","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, TYPE 1, DMS1","code_information":[{"code":"3002419","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, TYPE 2, DMS1","code_information":[{"code":"3002420","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO AMPHYIPHYSIN AB, S, DMS1","code_information":[{"code":"3002421","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-GLIAL NUCLEAR AB, TYPE 1, DMS1","code_information":[{"code":"3002422","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NMDA-R AB CBA, SERUM, DMS1","code_information":[{"code":"3002423","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO AMPA-R AB CBA, SERUM, DMS1","code_information":[{"code":"3002424","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GABA-B-R AB CBA, SERUM, DMS1","code_information":[{"code":"3002425","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO LGI1-IGG CBA, S, DMS1","code_information":[{"code":"3002426","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CASPR2-IGG CBA, S, DMS1","code_information":[{"code":"3002427","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX AB SCREEN, PCABP","code_information":[{"code":"3002428","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO YO AB SCRN W/REFLX TO TITER AND WEST BLOT, FYABS","code_information":[{"code":"3002429","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":493.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX YO AB TITER EA AB, FYABT","code_information":[{"code":"3002430","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX YA AB WEST BLO,  FYABW","code_information":[{"code":"3002431","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":300.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX AB SCREEN LG1CS","code_information":[{"code":"3002432","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX CASPR2-IGG CBA S, CS2CS","code_information":[{"code":"3002433","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO UOI AMINO ACID SNGL QUAL, FILTER PAPER","code_information":[{"code":"3002434","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":261.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ANN1S","code_information":[{"code":"3002435","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ANN2S","code_information":[{"code":"3002436","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ANN3S","code_information":[{"code":"3002437","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PCABP","code_information":[{"code":"3002438","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PCAB2","code_information":[{"code":"3002439","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PCATR","code_information":[{"code":"3002440","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX AMPHS","code_information":[{"code":"3002441","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CRMS-CRMP 5 IGG","code_information":[{"code":"3002442","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CCPQ-P/Q","code_information":[{"code":"3002443","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":744.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CCN-N TYPE CA","code_information":[{"code":"3002444","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":744.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX VGKC-(V-A) K","code_information":[{"code":"3002445","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":844.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CS2CS-CASPR2","code_information":[{"code":"3002446","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MANGANESE-B MNB","code_information":[{"code":"3002447","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":572.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MANGANESE-SERUM MNS","code_information":[{"code":"3002448","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CD-20 ON B CELLS CD20B","code_information":[{"code":"3002449","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CD20 TOTAL COUNT CD20B","code_information":[{"code":"3002450","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":388.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BABESAI MICROTI AB IGG IGM MAYO FBGM","code_information":[{"code":"3002480","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BABESAI MICROTI AB IGG IGM EA ADDL MAYO FBGM","code_information":[{"code":"3002481","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO HERPES SIMPLEX VIRUS, LHSVB","code_information":[{"code":"3002516","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CYTOMEGALOVIRUS,QUANT PCR LAB TEST","code_information":[{"code":"3002517","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.0,"discounted_cash":401.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ADALIMUMAB QUANT W/REFLEX TO AB ADALX","code_information":[{"code":"3002519","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1337.0,"discounted_cash":802.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ADALIMUMAB AB ADLAB","code_information":[{"code":"3002520","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEPATITIS A IGG AB HAIGG","code_information":[{"code":"3002521","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PLASMINOGEN ACTVTR INHBT ANTIGEN PAI1","code_information":[{"code":"3002522","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN, EACH ANTIBODY, INITIAL DMC1","code_information":[{"code":"3002523","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN, EACH ANTIBODY, ADDL, DMC1","code_information":[{"code":"3002524","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FLOURESCENT ANTIBODY SCREEN PAC1","code_information":[{"code":"3002525","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLOURESCENT ANTIBODY SCREEN ADDL ANTIBODY, PAC1","code_information":[{"code":"3002526","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX GD65C","code_information":[{"code":"3002527","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":1245.0,"discounted_cash":747.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX AMPCC","code_information":[{"code":"3002528","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1292.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX LG1CC","code_information":[{"code":"3002529","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLUTAMIC ACID DECARB AB GD65C, DMC1","code_information":[{"code":"3002530","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CS2CC","code_information":[{"code":"3002531","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX NMDCC","code_information":[{"code":"3002532","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1292.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX GABCC","code_information":[{"code":"3002533","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1292.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX VGKCC","code_information":[{"code":"3002534","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":844.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VGKC COMPLEX AB IPA, CSF DMC1","code_information":[{"code":"3002535","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CORTISOL, FREE; CORTF","code_information":[{"code":"3002536","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":360.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC INF AGENT DETECT BY NA (DNA OR RNA), GIP","code_information":[{"code":"3002537","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1695.0,"discounted_cash":1017.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX AMPIC","code_information":[{"code":"3002538","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX WBNC","code_information":[{"code":"3002539","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":744.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX GABIC","code_information":[{"code":"3002540","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CRMWC","code_information":[{"code":"3002541","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":744.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX NMDIC","code_information":[{"code":"3002542","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMPHIPHYSIN WEST BLOT, CSF ABLTC","code_information":[{"code":"3002543","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1241.0,"discounted_cash":744.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMIC AB TYPE 1, PCA1C","code_information":[{"code":"3002544","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":886.0,"discounted_cash":531.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX NMOFC","code_information":[{"code":"3002545","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX NMOTC","code_information":[{"code":"3002546","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SYPHILIS AB, TPPA","code_information":[{"code":"3002547","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO 21 HYDROXYLASE AB, OH21","code_information":[{"code":"3002548","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR MUSCLE BINDING AB ARBI, MGA1","code_information":[{"code":"3002549","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO STRIATED MUSCLE AB STR, MGA1","code_information":[{"code":"3002550","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR MUSCLE MODULATING AB ARMO, MGA1","code_information":[{"code":"3002551","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURONAL V-G K+ CHANNEL AB, VGKC","code_information":[{"code":"3002552","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":844.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INFLIXIMAB QN WITH REFLEX TO AB, INFXR","code_information":[{"code":"3002553","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":541.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INFLIXIMAB AB, INXAB","code_information":[{"code":"3002554","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VORICONAZOLE, VORI","code_information":[{"code":"3002555","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LYME DISEASE SEROLOGY, TICKS","code_information":[{"code":"3002556","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BABESIA MICROTI IGG AB, TICKS","code_information":[{"code":"3002557","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANAPLASMA PHAGOCYTOPHILUM AB, ANAP TICKS","code_information":[{"code":"3002558","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHIA AB EHRCP TICKS","code_information":[{"code":"3002559","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO NON-INTERFACED, SCID/TREC, NEONATAL SCREEN","code_information":[{"code":"3002560","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, LSDS, NEONATAL SCREEN","code_information":[{"code":"3002561","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRICHOMONAS VAGINALIS AMP RNA, TVRNA","code_information":[{"code":"3002562","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CREATINE CONCENTRATION, CRE, MNCRU","code_information":[{"code":"3002563","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MANGANESE CONCENTRATION, RATIO, MNCRU","code_information":[{"code":"3002564","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":296.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC CULTURE, SCREENING ONLY","code_information":[{"code":"3002585","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC CARCINOEMBRYONIC ANTIGEN (CEA)","code_information":[{"code":"3002591","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.0,"discounted_cash":651.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INTERPACE AMYLASE, INT AMYL","code_information":[{"code":"3002592","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY; PARVOVIRUS, PARVS","code_information":[{"code":"3002593","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY; PARVOVIRUS, ADDL PARVS","code_information":[{"code":"3002594","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":50.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO GALT TRANS, GCT","code_information":[{"code":"3002595","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82775","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ZIKA VIRS PCR MOLEC DET, RZIKS","code_information":[{"code":"3002596","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":622.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ZIKA VIR IGM ANTI MAC ELISA, MZIKV","code_information":[{"code":"3002597","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PANCREATIC POLYPEPTIDE, P, HPP 83519","code_information":[{"code":"3002598","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HUMAN EPIDIDYMIS PROTEIN 4,HE4 83605","code_information":[{"code":"3002599","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.0,"discounted_cash":359.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CARBOHYDRATE DEF TRANSFERRIN, CDG, 82373","code_information":[{"code":"3002600","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NTX-TELOPEPTIDE, S, SNTX","code_information":[{"code":"3002601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":319.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC FLU A & B PCR LAB TEST","code_information":[{"code":"3002602","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":376.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEPATITIS A IGM AB SERUM HAIGM","code_information":[{"code":"3002607","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO B CELL TOTAL CNT, CD20B","code_information":[{"code":"3002608","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":546.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CD20 TOTAL CNT, CD20B","code_information":[{"code":"3002609","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":388.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHOSPHATASE, ALKALINE; ISOENZYMES, BAP","code_information":[{"code":"3002612","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEAVY METAL; QUANTITATIVE, EACH, TIS","code_information":[{"code":"3002613","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC HEP B CORE AB TOTAL LAB TEST","code_information":[{"code":"3002614","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INTERLEUKIN 6 HIGHLY SENSITIVE IL6","code_information":[{"code":"3002618","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LEAD WITH DEMOGRAPHICS BLOOD PBDB","code_information":[{"code":"3002619","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE, CA19-9","code_information":[{"code":"3002620","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC URINE CULTURE/COLON COUNT 87086","code_information":[{"code":"3002631","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY; HEPATITIS, DELTA AGENT, AHDV","code_information":[{"code":"3002663","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HBV DNA DETECT/QUANT, HBVQN","code_information":[{"code":"3002665","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PS/PT AB, IGG, PSPTG","code_information":[{"code":"3002666","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PS/PT AB, IGM, PSPTM","code_information":[{"code":"3002667","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO LYME AB SEROLOGY, LNBAB","code_information":[{"code":"3002670","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":100.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ALBUMIN SERUM, LNBAI","code_information":[{"code":"3002671","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ALBUMIN OTHER, LNBAI","code_information":[{"code":"3002672","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX LYME AB INITIAL, LNBAI","code_information":[{"code":"3002673","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX LYME AB ADDITIONAL, LNBAI","code_information":[{"code":"3002674","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":455.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO REFLEX IMMG INITIAL, LNBAI","code_information":[{"code":"3002675","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX IMMG ADDITIONAL, LNBAI","code_information":[{"code":"3002676","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ZIKA VIRUS IGM AB CAPTURE MAC-ELISA, MZIKV","code_information":[{"code":"3002677","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86794","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ZIKA VIRUS PCR MOLECULAR DETECT, RZIKS","code_information":[{"code":"3002678","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":657.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC BB ANTIBODY ELUTION","code_information":[{"code":"3002679","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PAIN 250 IMMUNOASSAY PANEL, U PNCSU","code_information":[{"code":"3002681","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":586.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA CULTURE, FCLCU","code_information":[{"code":"3002682","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA TYPE IMMUNOFLUORESC, FCLCU","code_information":[{"code":"3002683","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":65.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV-1 DNA/RNA QUALIZTIVE P, HIVP","code_information":[{"code":"3002684","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AFP SINGLE MARKER SCRN MATERNAL SERUM, MAFP1","code_information":[{"code":"3002685","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BETA -2 MIRCROGLOBULIN URNIE, B2MU","code_information":[{"code":"3002686","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":436.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BETA 2TRANSFERRIN BF, BETA2","code_information":[{"code":"3002687","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGG/ALBUMIN RATIO ALB CSF, CASF","code_information":[{"code":"3002688","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGG/ALBUMIN RATIO IGG CSF, CASF","code_information":[{"code":"3002689","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRUCELLA AB SCREEN, IGG, BRUGM","code_information":[{"code":"3002690","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRUCELLA AB SCREEN, IGM, BRUGM","code_information":[{"code":"3002691","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO BRUCELLA TOTAL AB CONFIRMATION, AGGLUTINATION, BRUTA","code_information":[{"code":"3002692","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":402.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRICHOMONAS VAGINALIS, MTRNA","code_information":[{"code":"3002693","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BETA 2 MICROGLOBULIN B2MU","code_information":[{"code":"3002694","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":436.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROMIUM OCCUPATIONAL MONITORING CRE, CROMU","code_information":[{"code":"3002695","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROMIUM OCCUPATIONAL MONITORING CONCENTRATION, CROMU","code_information":[{"code":"3002696","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO C4ADES ARG LEVEL, FC4A","code_information":[{"code":"3002697","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ZINC TRANSPORTER 8 AB, EZNT8","code_information":[{"code":"3002698","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHIAL ANAPLASMA MOLECULAR DETECTION, EHRL INT","code_information":[{"code":"3002699","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":47.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHIAL ANAPLASMA MOLECULAR DETECTION ADD'L, EHRL INT","code_information":[{"code":"3002700","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":47.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ETHYL GLUCURONIDE SCREEN, ETGS","code_information":[{"code":"3002701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ADMARK PHOSPHO-TAU/TOTAL-TAU/AB42, INITIAL FADMK","code_information":[{"code":"3002702","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2203.0,"discounted_cash":1321.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ADMARK PHOSPHO-TAU/TOTAL-TAU/AB42, ADD'L FADMK","code_information":[{"code":"3002703","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2203.0,"discounted_cash":1321.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CLOMIPRAMINE, CLOM","code_information":[{"code":"3002704","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYCLOSPORINE, PEAK, CYCPK","code_information":[{"code":"3002705","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LEAD VENOUS W/DEMO, BLOOD PBDV","code_information":[{"code":"3002706","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REF FERN","code_information":[{"code":"3002707","type":"CDM"},{"code":"0300","type":"RC"},{"code":"Q0114","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC WHOLE ALLERGEN, PEACMP LAB TEST","code_information":[{"code":"3002711","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC COMP ALLERGEN, ADL PEACMP LAB TEST","code_information":[{"code":"3002712","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC COMP ALLERGEN, ADL PEACMP LAB TEST","code_information":[{"code":"3002713","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC WHOLE ALLERGEN, MILKPN LAB TEST","code_information":[{"code":"3002714","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC COMP ALLERGEN, INIT, MILKPN LAB TEST","code_information":[{"code":"3002715","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC COMP ALLERGEN, ADL MILKPN LAB TEST","code_information":[{"code":"3002716","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC COMP ALLERGEN, INIT, EGGPN LAB TEST","code_information":[{"code":"3002717","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC COMP ALLERGEN, ADL, EGGPN LAB TEST","code_information":[{"code":"3002718","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HERPES SIMPLEX VIRUS,AMPLIFIED PROBE ADDTL, LHSV","code_information":[{"code":"3002720","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRYPANOSOMA CRUZI AB IGG S CHAG","code_information":[{"code":"3002721","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENZ CELL ACTIVITY DHR","code_information":[{"code":"3002722","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IADNA NOS QUANTIF EACH ORGANISM EBVQU","code_information":[{"code":"3002723","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC YEAST ONE, 87186 LAB TEST","code_information":[{"code":"3002724","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CERAMIDE TRIHEX AND SULFATIDE, CTSA","code_information":[{"code":"3002725","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":558.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENC1 ANNA2","code_information":[{"code":"3002726","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENC1 ANNA1","code_information":[{"code":"3002727","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 PCA-1","code_information":[{"code":"3002728","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 AMPHIPHYSIN","code_information":[{"code":"3002729","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 PCA-TR","code_information":[{"code":"3002730","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 PCA-2","code_information":[{"code":"3002731","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 ANNA3","code_information":[{"code":"3002732","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 CRMP5","code_information":[{"code":"3002733","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 GAD65","code_information":[{"code":"3002734","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENC1 AGNA-1","code_information":[{"code":"3002735","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 NMDA-R","code_information":[{"code":"3002736","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 AMPA-R","code_information":[{"code":"3002737","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 GABA-B-R","code_information":[{"code":"3002738","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 VGKC","code_information":[{"code":"3002739","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENC1 LGI1","code_information":[{"code":"3002740","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENC1 CASPR2","code_information":[{"code":"3002741","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO COCCIDIODES AB, RSCOC COMP FIX","code_information":[{"code":"3002742","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO COCCIDIODES AB, RSCOC ID IGG","code_information":[{"code":"3002743","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO COCCIDIODES AB, RSCOC ID IGM","code_information":[{"code":"3002744","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO COCCIDIODES AB, COXIS","code_information":[{"code":"3002745","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENTEROVIRUS, ENTP","code_information":[{"code":"3002746","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VIRAL CULTURE RESPIRATORY, VRESP","code_information":[{"code":"3002747","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEPATITIS C VIRUS GENO, HCVGR","code_information":[{"code":"3002748","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC FLOW CYTOMETRY TC1 MARKER 88184","code_information":[{"code":"3002752","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO APOLIPOPROTEIN FIBRO APO","code_information":[{"code":"3002764","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALPHA 2 MACROGLOBULIN FIBRO A2MF","code_information":[{"code":"3002765","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HAPTOGLOBIN FIBRO HAP","code_information":[{"code":"3002766","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALANINE AMINOTRANSFERASE FIBRO ALT","code_information":[{"code":"3002767","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GAMMA GLUTAMYITRANSFERASE FIBRO GGT","code_information":[{"code":"3002768","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BILIRUBIN TOTAL FIBRO TBIL","code_information":[{"code":"3002769","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, CORDSTAT 9 TOXICOLOGY","code_information":[{"code":"3002770","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON-INTERFACED, MECONIUM 9 TOXICOLOGY","code_information":[{"code":"3002771","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO C RE1 PROTEIN HIGH SENS HSCRP1","code_information":[{"code":"3002772","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SELENIUM, SEWB, LC 081034","code_information":[{"code":"3002774","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INFECT AGENT, MULTI, AMPL PROBE(S); BRBPS","code_information":[{"code":"3002775","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.0,"discounted_cash":895.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CULTURE TYPING;ID BY NUC ACID SEQ, ISBA, BRBPS","code_information":[{"code":"3002776","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":388.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO QUANTITATION OF THERAPEUTIC DRUG, NOT ELSEWHERE SPECIFIED, FVEDO","code_information":[{"code":"3002780","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY ANALYTE; QUANTITATIVE, NOT OTHERWISE SPECIFIED, FVEDO","code_information":[{"code":"3002781","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC HISTOPLASMA AB ADDTL LAB TEST","code_information":[{"code":"3002782","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":103.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO PANCREATIC ELASTASE-1, FPAN1","code_information":[{"code":"3002783","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82656","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":257.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACETYCHOLINE BINDING AB, FABAB","code_information":[{"code":"3002784","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THROMBIN AT3 ACTIVITY, THRMP","code_information":[{"code":"3002785","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THROMBIN TIME, THRMP","code_information":[{"code":"3002786","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THROMBIN APTT, THRMP","code_information":[{"code":"3002787","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROTHROMBIN PT, THRMP","code_information":[{"code":"3002788","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO D-DIMER, THRMP","code_information":[{"code":"3002789","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":65.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROTEIN C ACTIVITY, THRMP","code_information":[{"code":"3002790","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACTIVATED PROTEIN RESISTANCE V, THRMP","code_information":[{"code":"3002791","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO PROTEIN S AG, THRMP","code_information":[{"code":"3002792","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO RUSS VIPER VENOM DRVVT, THRMP","code_information":[{"code":"3002793","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBRINOGEN, THRMP","code_information":[{"code":"3002794","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBRIN MONOMER, THRMP","code_information":[{"code":"3002795","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85366","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR V, THRMP","code_information":[{"code":"3002796","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR XI, THRMP","code_information":[{"code":"3002797","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR II, THRMP","code_information":[{"code":"3002798","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX DRVVT CONFIRM, DRVTC THRMP","code_information":[{"code":"3002799","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR VII, THRMP","code_information":[{"code":"3002800","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR XII, THRMP","code_information":[{"code":"3002801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PLATELET NEUTRAL FOR LUPUS, PNP THRMP","code_information":[{"code":"3002802","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85597","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR VIII INHIBITOR, IBETH THRMP","code_information":[{"code":"3002803","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":391.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR IX THRMP","code_information":[{"code":"3002804","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR VIII AHG, F8A THRMP","code_information":[{"code":"3002805","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PT MIX 1:1, PTMX THRMP","code_information":[{"code":"3002806","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX BETHESDA TITER, F8IS THRMP","code_information":[{"code":"3002807","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.0,"discounted_cash":538.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FACTOR 10, F10 THRMP","code_information":[{"code":"3002808","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX REPITALASE TIME, RPTL THRMP","code_information":[{"code":"3002809","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX APTT MIX 1:1, APTTM THRMP","code_information":[{"code":"3002810","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX STACLOT LA, STLA THRMP","code_information":[{"code":"3002811","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX DRVVT MIX, DRVTM THRMP","code_information":[{"code":"3002812","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":229.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PROTEIN S ACTIVITY, S FX, THRMP","code_information":[{"code":"3002813","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CREATININE; OTHER SOURCE, CREA, CDUO","code_information":[{"code":"3002814","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CADMIUM, CDUO","code_information":[{"code":"3002815","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":451.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CADMIUM, HMU24","code_information":[{"code":"3002816","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":587.0,"discounted_cash":352.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ARSENIC, HMU24","code_information":[{"code":"3002817","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.0,"discounted_cash":289.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MERCURY, QUANTITATIVE, HMU24","code_information":[{"code":"3002818","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LEAD, HMU24","code_information":[{"code":"3002819","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ARSENIC FRACTIONATION, ASFR","code_information":[{"code":"3002820","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC NON INTERFACED CLOTTING FUNC ACT, VWFGP","code_information":[{"code":"3002822","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NMO/AQP4 FACS, CDS1","code_information":[{"code":"3002823","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1916.0,"discounted_cash":1149.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NMO/AQP4 FACS, ADDTL CDS1","code_information":[{"code":"3002824","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1916.0,"discounted_cash":1149.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOG FACS, MOGFS","code_information":[{"code":"3002825","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2514.0,"discounted_cash":1508.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX MOG FACS, MOGFS MOGTS","code_information":[{"code":"3002826","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REF IADNA-DNA/RNA PROBE TQ 12-25","code_information":[{"code":"3002827","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1493.0,"discounted_cash":895.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REF LEVETIRACETAM, LEVET","code_information":[{"code":"3002828","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURONAL VGKC AUTOANTIBODY, ENS1","code_information":[{"code":"3002829","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR (MUSCLE) BINDING AB, ARBI, ENS1","code_information":[{"code":"3002830","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NEUROIMMUNOLOGY ANTIBODY FOLLOW UP, CCN, ENS1","code_information":[{"code":"3002831","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO P/Q-TYPE CALCIUM CHANNEL ANTIBODY, CCPQ, ENS1","code_information":[{"code":"3002832","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ACHR GANGLIONIC NEURONAL ANTIBODY, GANG, ENS1","code_information":[{"code":"3002833","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GAD65 AB ASSAY, ENS1","code_information":[{"code":"3002834","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AUTOIMMUNE GI DYSMOTILITY EVAL, NMDCS, ENS1","code_information":[{"code":"3002835","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LGI1-IGG CBA, LG1CS, ENS1","code_information":[{"code":"3002836","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CASPR2-IGG CBA, CS2CS, ENS1","code_information":[{"code":"3002837","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GABA-B-R AB CBA, GABSC, ENS1","code_information":[{"code":"3002838","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO AMPHIPHYSIN AB, AMPHS, ENS1","code_information":[{"code":"3002839","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO AMPA-R AB CBA, AMPCS, ENS1","code_information":[{"code":"3002840","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, ANN1S, ENS1","code_information":[{"code":"3002841","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, ANN2S, ENS1","code_information":[{"code":"3002842","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, ANN3S, ENS1","code_information":[{"code":"3002843","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-GLIAL NUCLEAR AB, AGN1S, ENS1","code_information":[{"code":"3002844","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMIC AB, PCABP, ENS1","code_information":[{"code":"3002845","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMIC AB, PCAB2, ENS1","code_information":[{"code":"3002846","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMIC AB, PCATR, ENS1","code_information":[{"code":"3002847","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CRMP-5-IGG, CRMS, ENS1","code_information":[{"code":"3002848","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NEURONAL (V-G) K+ CHANNEL AB, VGKC, EPS1","code_information":[{"code":"3002849","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR (MUSCLE) BINDING AB, ARBI, EPS1","code_information":[{"code":"3002850","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO N-TYPE CALCIUM CHANNEL AB, CCN, EPS1","code_information":[{"code":"3002851","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO P/Q-TYPE CALCIUM CHANNEL AB, CCPQ, EPS1","code_information":[{"code":"3002852","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ACHR GANGLIONIC NEURONAL AB, GANG, EPS1","code_information":[{"code":"3002853","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GAD65 AB ASSAY, GD65S, EPS1","code_information":[{"code":"3002854","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NMDA-R AB CBA, NMDCS, EPS1","code_information":[{"code":"3002855","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO LGI1-IGG CBA, LG1CS, EPS1","code_information":[{"code":"3002856","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CASPR2-IGG CBA, CS2CS, EPS1","code_information":[{"code":"3002857","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GABA-B-R AB CBA, GABCS, EPS1","code_information":[{"code":"3002858","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO AMPHIPHYSIN AB, AMPHS, EPS1","code_information":[{"code":"3002859","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO AMPA-R AB CBA, AMPCS, EPS1","code_information":[{"code":"3002860","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, ANN1S, EPS1","code_information":[{"code":"3002861","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, ANN2S, EPS1","code_information":[{"code":"3002862","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-NEURONAL NUCLEAR AB, ANN3S, EPS1","code_information":[{"code":"3002863","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTI-GLIAL NUCLEAR AB, AGN1S, EPS1","code_information":[{"code":"3002864","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMIC AB, PCAB2, EPS1","code_information":[{"code":"3002865","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PURKINJE CELL CYTOPLASMIC AB, PCATR, EPS1","code_information":[{"code":"3002866","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CRMP-5-IGG, CRMS, EPS1","code_information":[{"code":"3002867","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GROWTH DIFFERENTIATION FACTOR 15, GDF15","code_information":[{"code":"3002868","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECPTOR (MUSCLE) BINDING ANTIBDY, MGRM","code_information":[{"code":"3002869","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ACH RECEPTOR (MUSCLE) MODULATING ANTIBDY, MGRM","code_information":[{"code":"3002870","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO STRIATIONAL (STRIATED MUCLE) ANTIBDY, MGRM","code_information":[{"code":"3002871","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":184.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG TEST, PRESUMPTIVE, BY CHEMISTRY ANALYZERS, CORD13","code_information":[{"code":"3002872","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":477.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG TEST, PRESUMPTIVE, BY CHEMISTRY ANALYZERS, MEC13","code_information":[{"code":"3002873","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO QUANTITATION OF THERAPEUTIC DRUG, NOT ELSEWHERE SPECIFIED, VEDOZ","code_information":[{"code":"3002874","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":424.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHEMILUMINESCENT ASSAY, ANTIBODY, VEMAB, VEDOZ","code_information":[{"code":"3002875","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HERPES SIMPLEX VIRUS,AMPLIFIED PROBE, HSV1, HERPB","code_information":[{"code":"3002876","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HERPES SIMPLEX VIRUS,AMPLIFIED PROBE, HSV2, HERPB","code_information":[{"code":"3002877","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HERPES SIMPLEX VIRUS,AMPLIFIED PROBE, HSV 1, HERPV","code_information":[{"code":"3002878","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HERPES SIMPLEX VIRUS,AMPLIFIED PROBE, HSV 2, HERPV","code_information":[{"code":"3002879","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REDUCING SUBSTANCE UREDF","code_information":[{"code":"3002886","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MCRNA, C TRACH, MISC, AMPLIFIED RNA, MCTGC","code_information":[{"code":"3002887","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MGRNA, N GONORR, MISC, AMPLIFIED RNA, MCTGC","code_information":[{"code":"3002888","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MISC ASSAY FREE THYROXINE, 84439","code_information":[{"code":"3002894","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; MOLD, FUNID","code_information":[{"code":"3002905","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ZIKA VIRS PCR MOLEC DET, RZIKS","code_information":[{"code":"3002906","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":683.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX T CRUZI IGG, LFA, RCHAG","code_information":[{"code":"3002908","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.0,"discounted_cash":559.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REF LAB STACLOT, LAB TEST","code_information":[{"code":"3002909","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REF LAB, DRVV, MIX LAB TEST","code_information":[{"code":"3002910","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":81.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REF LAB DRVV CONFIRMATION, LAB TEST","code_information":[{"code":"3002911","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO DIHYDROTESTOERONE DHTS LAB TEST","code_information":[{"code":"3002912","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBRO ACTI LAB TEST","code_information":[{"code":"3002913","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":1446.0,"discounted_cash":867.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF MYCOBAC ID SUSC LAB TEST","code_information":[{"code":"3002914","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED  METO1 LAB TEST","code_information":[{"code":"3002915","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":682.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED MET07 LAB TEST","code_information":[{"code":"3002916","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED NC01 LAB TEST","code_information":[{"code":"3002917","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED NC03 LAB TEST","code_information":[{"code":"3002918","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":555.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED  NC04 LAB TEST","code_information":[{"code":"3002919","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED  NC04 HIAA LAB TEST","code_information":[{"code":"3002920","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED NC04 HVA LAB TEST","code_information":[{"code":"3002921","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83150","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INTERF CSF PED NC05 PHOS LAB TEST","code_information":[{"code":"3002922","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NONINTERFACED CORD ETHYL GLUCURONIDE, ETG","code_information":[{"code":"3002932","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.0,"discounted_cash":124.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY; CYTOMEGALOVIRUS (CMV), FCYTG LAB TEST","code_information":[{"code":"3002933","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC MYCOBACTERIA TUBERCULOSIS, DNA/RNA AMPLIFIED PROBE MTB LAB TEST","code_information":[{"code":"3002934","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 1 DONOR UNIT","code_information":[{"code":"3002936","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 2 DONOR UNIT","code_information":[{"code":"3002937","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 3 DONOR UNIT","code_information":[{"code":"3002938","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 4 DONOR UNIT","code_information":[{"code":"3002939","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN RARE TYPE DONOR UNIT","code_information":[{"code":"3002940","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":388.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 1 PATIENT","code_information":[{"code":"3002941","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 2 PATIENT","code_information":[{"code":"3002942","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 3 PATIENT","code_information":[{"code":"3002943","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN TYPE TIER 4 PATIENT","code_information":[{"code":"3002944","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":474.0,"discounted_cash":284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVRBC ANTIGEN RARE TYPE PATIENT","code_information":[{"code":"3002945","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":388.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LIVER DIS 10 ASSAYS W/NASH,  NSFIB","code_information":[{"code":"3002946","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0003M","type":"HCPCS"}],"standard_charges":[{"gross_charge":1796.0,"discounted_cash":1077.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIEPILEPTICS, NOS, 1-3, CLOBZ","code_information":[{"code":"3002947","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COPEPTIN PROAVP, CPAVP","code_information":[{"code":"3002949","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO HLA I TYPING 1 ALLELE HR, HL57V","code_information":[{"code":"3002950","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO CALIF VIR IGG, SER, ABOPC","code_information":[{"code":"3002951","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CALIF VIR IGM,SER, ABOPC","code_information":[{"code":"3002952","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ST. LOUIS, ENCEP,SER, IGG","code_information":[{"code":"3002953","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ST. LOUIS, ENCEP,SER, IGM","code_information":[{"code":"3002954","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO E. EQUINE ENCEP SER,, IGG","code_information":[{"code":"3002955","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO E. EQUINE ENCEP SER, IGM","code_information":[{"code":"3002956","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO W. EQUINE ENCEP, SER, IGG","code_information":[{"code":"3002957","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO W. EQUINE ENCEP, SER,IGM","code_information":[{"code":"3002958","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CALIF VIR IGG, CSF ABOPC","code_information":[{"code":"3002959","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CALIF VIR IGM,CSF ABOPC","code_information":[{"code":"3002960","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ST. LOUIS, ENCEP,CSF IGG","code_information":[{"code":"3002961","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ST. LOUIS, ENCEP,CSF IGM","code_information":[{"code":"3002962","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO E. EQUINE ENCEP CSF, IGG","code_information":[{"code":"3002963","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO E. EQUINE ENCEP CSF  IGM","code_information":[{"code":"3002964","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO W. EQUINE ENCEP, CSF IGG","code_information":[{"code":"3002965","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO W. EQUINE ENCEP, CSF IGM","code_information":[{"code":"3002966","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PENTOBARBITAL, PENTS","code_information":[{"code":"3002967","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCR, EA AB, INITIAL, DMC2","code_information":[{"code":"3002968","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCR, EA AB, ADD'L, DMC2","code_information":[{"code":"3002969","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":121.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLUTAMIC ACID DECARB, GD65C, DMC2","code_information":[{"code":"3002970","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCR, EA AB, INITIAL, ENC2","code_information":[{"code":"3002971","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCR, EA AB, ADD'L, ENC2","code_information":[{"code":"3002972","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLUTAMIC ACID DECARB, GD65C, ENC2","code_information":[{"code":"3002973","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":227.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN EA ANTIBODY, INITIAL, EPS2","code_information":[{"code":"3002974","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN EA ANTIBODY, ADDL  EPS2","code_information":[{"code":"3002975","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLUTAMIC ACID DECARB AB GAD65, EPS2","code_information":[{"code":"3002976","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, INITIAL, EPS2","code_information":[{"code":"3002977","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, ADD'L, EPS2","code_information":[{"code":"3002978","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN EA ANTIBODY, INITIAL, ENS2","code_information":[{"code":"3002979","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN EA ANTIBODY, ADDL  ENS2","code_information":[{"code":"3002980","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLUTAMIC ACID DECARB AB GAD65, ENS2","code_information":[{"code":"3002981","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, INITIAL, ENS2","code_information":[{"code":"3002982","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, ADD'L, ENS2","code_information":[{"code":"3002983","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":106.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN EA ANTIBODY, INITIAL, DMS2","code_information":[{"code":"3002984","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY; SCREEN EA ANTIBODY, ADDL  DMS2","code_information":[{"code":"3002985","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLUTAMIC ACID DECARB AB GAD65, DMS2","code_information":[{"code":"3002986","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, INITIAL, DMS2","code_information":[{"code":"3002987","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, ADD'L, DMS2","code_information":[{"code":"3002988","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX, FLUORESCENT EA AB SCREEN , DPPCS","code_information":[{"code":"3002991","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT AB TITER, DPPTS","code_information":[{"code":"3002992","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT EA AB SCREEN, GL1CS","code_information":[{"code":"3002993","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT AB TITER, GL1TS","code_information":[{"code":"3002994","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT EA AB SCREEN, GFACS","code_information":[{"code":"3002995","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT AB TITER, GFATS","code_information":[{"code":"3002996","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NMR LIPOPROTEIN BLD QUAN PAR, NMRLP","code_information":[{"code":"3002997","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 7, BRCRC","code_information":[{"code":"3002998","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":304.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PTEN GENE FULL SEQUENCE, BRCRC","code_information":[{"code":"3002999","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1079.0,"discounted_cash":647.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 6, BRCRC","code_information":[{"code":"3003000","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MLH1 GENE FULL SEQ, BRCRC","code_information":[{"code":"3003001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":729.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MSH2 GENE FULL SEQ, BRCRC","code_information":[{"code":"3003002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81295","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":411.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MSH6 GENE FULL SEQ, BRCRC","code_information":[{"code":"3003003","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":691.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PMS2 GENE FULL SEQ ANALYSIS, BRCRC","code_information":[{"code":"3003004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":729.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 4, BRCRC","code_information":[{"code":"3003005","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":199.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PMS2 GENE DUP/DELET VARIANTS, BRCRC","code_information":[{"code":"3003006","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81319","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGEN MICRARRAY COPY NMBR, BRCRC","code_information":[{"code":"3003007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81228","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":970.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 6 ADDTL, BRCRC","code_information":[{"code":"3003008","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MAGNESIUM, 24HR URINE, MAGU","code_information":[{"code":"3003009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC HEPATITIS A ANTIBODY IGG LAB TEST","code_information":[{"code":"3003010","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":143.0,"discounted_cash":85.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO NONANTIBODY ASSAY BP180, BP","code_information":[{"code":"3003011","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NONANTIBODY ASSAY BP230, BP","code_information":[{"code":"3003012","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MASS SPEC QUAL/QUAN, IODINE, IOD","code_information":[{"code":"3003013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO QUANT POSACONAZOLE, POSA","code_information":[{"code":"3003014","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF ARSENIC HAIR, ASHA","code_information":[{"code":"3003015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":1042.0,"discounted_cash":625.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGG 4 SUBCLASS,IGGS4","code_information":[{"code":"3003016","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT NONINFECT AB SCREEN EA, DPPCC","code_information":[{"code":"3003017","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT NONINFECT AB TITER EA, DPPTC","code_information":[{"code":"3003018","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT NONINFECT AB TITER EA, GFATC","code_information":[{"code":"3003019","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT NONINFECT AB SCREEN EA, GL1CC","code_information":[{"code":"3003020","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT NONINFECT AB TITER EA, GL1TC","code_information":[{"code":"3003021","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82656","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX, FLUORESCENT NONINFECT AB SCREEN EA, GFACC","code_information":[{"code":"3003022","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1197.0,"discounted_cash":718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LEUKOCYTE HISTAMINE RELEASE, FCUIX","code_information":[{"code":"3003061","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86343","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"discounted_cash":459.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CALCULUS SPECTROSCOPY KIDST","code_information":[{"code":"3003073","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AG DETECT NOS IA MULT, SFUNG","code_information":[{"code":"3003074","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":373.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCR, DPPIS","code_information":[{"code":"3003075","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCR, GL1IS","code_information":[{"code":"3003076","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC ASSAY OF TOPIRAMATE","code_information":[{"code":"3003077","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":261.0,"discounted_cash":156.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC DRUG SCREEN QUAN LAMOTRIGINE","code_information":[{"code":"3003078","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":141.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO OPIOID & OPIATE ANALOG 5/MORE, CSMP","code_information":[{"code":"3003079","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG TEST PRSMV CHEM ANLYZR, CSMP","code_information":[{"code":"3003080","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BENZODIAZEPINES 13 OR MORE, CSMP","code_information":[{"code":"3003081","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":184.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF ETHOSUXIMIDE, ETX","code_information":[{"code":"3003082","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BULLOUS PEMPHIGOID 180, BPAB","code_information":[{"code":"3003084","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BULLOUS PEMPHIGOID 180 ADDTL, BPAB","code_information":[{"code":"3003085","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFELX REPTILASE TIME, RTSC","code_information":[{"code":"3003086","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AT3 ACTIVITY, ATTF, AATHR","code_information":[{"code":"3003087","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOT INHIBIT PROT C ACTIVITY, CFX, AATHR","code_information":[{"code":"3003088","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO  ACTIVATED PROTEIN C RESIST, APCRV, AATHR","code_information":[{"code":"3003089","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOT INHIBIT PROT S FREE, PSF, AATHR","code_information":[{"code":"3003090","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO F2 GENE G20210A MUTATION, PTNP, AATHR","code_information":[{"code":"3003091","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":899.0,"discounted_cash":539.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROTHROMBIN TIME, PTSC, AATHR","code_information":[{"code":"3003092","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO APTT ,APTSC, AATHR","code_information":[{"code":"3003093","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THROMBIN TIME PLASMA, TTSC, AATHR","code_information":[{"code":"3003094","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBRINOGEN ACTIVITY, CLFIB, AATHR","code_information":[{"code":"3003095","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIB DEGRADTION ,DIMER, AATHR","code_information":[{"code":"3003096","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DILUTED RUSSELL VIPER VENOM, RVR1, AATHR","code_information":[{"code":"3003097","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PT FIBRINOGEN, PTFIB","code_information":[{"code":"3003098","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX SOLUABLE FIBRIN MONOMER, SOLFM","code_information":[{"code":"3003099","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85366","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":591.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX DRVVT CONFIRMATION, DRV3","code_information":[{"code":"3003100","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX DRVVT MIX , DRV2","code_information":[{"code":"3003101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":229.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX STACLOT, STACL","code_information":[{"code":"3003102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX APTT MIX 1:1, APMSC","code_information":[{"code":"3003103","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PT MIX 1:1, PTMSC","code_information":[{"code":"3003104","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ADALIMUMAB QUANT W/REFLEX TO AB ADALX","code_information":[{"code":"3003105","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":698.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INFLIXIMAB QN WITH REFLEX TO AB, INFXR","code_information":[{"code":"3003106","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LACOSAMIDE SERUM LACO","code_information":[{"code":"3003107","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":298.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO QUANT POSACONAZOLE, POSA","code_information":[{"code":"3003108","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80187","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"SO QUANTITATIVE ASSAY, QUANT, VEDOZ","code_information":[{"code":"3003109","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VORICONAZOLE, VORI","code_information":[{"code":"3003110","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTI XA, APIXABAN, APIXA","code_information":[{"code":"3003111","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":649.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO APOLIPOPROTEIN B, APOLB","code_information":[{"code":"3003112","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTI XA, RIVAROXABAN, RIVAR","code_information":[{"code":"3003113","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":649.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTI XA, ARIXTRA","code_information":[{"code":"3003114","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO APOLIPOPROTEIN A1, APOAB","code_information":[{"code":"3003115","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO APOLIPOPROTEIN B, APOAB","code_information":[{"code":"3003116","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO APOLIPOPROTEIN A1, APOA1","code_information":[{"code":"3003117","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO 21-HYDROXYLASE AB, 21OH","code_information":[{"code":"3003118","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE CREATININE, HEAVY METAL, HMSOR","code_information":[{"code":"3003119","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ARSENIC, HEAVY METAL, HMSOR","code_information":[{"code":"3003120","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CADMIUM, HEAVY METAL, HMSOR","code_information":[{"code":"3003121","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MERCURY, HEAVY METAL, HMSOR","code_information":[{"code":"3003122","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LEAD, HEAVY METAL, HMSOR","code_information":[{"code":"3003123","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRUG SCREEN QUAN LAMOTRIGINE","code_information":[{"code":"3003125","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC COAG TIME ACTIV TRAUMA TEG-R","code_information":[{"code":"3003126","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CLOT FX ACT TRAUMA TEG-EPL/LY30","code_information":[{"code":"3003127","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC PLATELET AGGREGATION TRAUMA TEG-MA","code_information":[{"code":"3003128","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":198.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CLOT FX ACTVTY TRAUMA TEG-CI","code_information":[{"code":"3003129","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ASSAY SERUM CHOLINESTERASE; PCHE1","code_information":[{"code":"3003130","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC COAG TIME ACTIV HEPARIN CARDIAC TEG-R","code_information":[{"code":"3003131","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":109.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC FIBRINOGEN ACTIV CARDIAC TEG-ANGLE","code_information":[{"code":"3003132","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":141.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC PLATELET AGG HEPARIN CARDIAC TEG-MA","code_information":[{"code":"3003133","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX FLOW/ TC 1 MARKER CSP53","code_information":[{"code":"3003134","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1465.0,"discounted_cash":879.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CELL FREE PRENATAL TRISOMY/SEX ANEUPLOIDY","code_information":[{"code":"3003135","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2693.0,"discounted_cash":1615.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BLASTOMYCES AG, FLUID, FBMO","code_information":[{"code":"3003136","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BLASTOMYCES AG, SERUM, FBMS","code_information":[{"code":"3003137","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BLASTOMYCES AG, URINE FBMU","code_information":[{"code":"3003138","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC MICROSATELLITE INSTABILITY","code_information":[{"code":"3003139","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1690.0,"discounted_cash":1014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC BRAF GENE","code_information":[{"code":"3003140","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.0,"discounted_cash":678.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC KRAS GENE VARIANTS EXON 2","code_information":[{"code":"3003141","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":781.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ETHYLENE GLYCOL, ETGL","code_information":[{"code":"3003142","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO F13, FUNCTIONAL, FFX3F","code_information":[{"code":"3003143","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85290","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":409.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BETA-HCG TUMOR MARKER, BHCG","code_information":[{"code":"3003144","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CLOT FX ACTVTY CARDIAC TEG-CI","code_information":[{"code":"3003145","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":253.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC CLOT FX HEPARIN CARDIAC TEG-EPL/LY30","code_information":[{"code":"3003146","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":253.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO 87635 SARS-COV-2 RNA RT PCR, COVID 19","code_information":[{"code":"3003147","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC COAG TIME ACTIV CARDIAC TEG-R","code_information":[{"code":"3003148","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":109.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC PLATELET AGGREGATION CARDIAC TEG-MA","code_information":[{"code":"3003149","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC CLOT FX ACT CARDIAC TEG-EPL/LY30","code_information":[{"code":"3003150","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":253.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALZHEIMER DISEASE EVAL, IN'T CSF, ADEVL","code_information":[{"code":"3003153","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1796.0,"discounted_cash":1077.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALZHEIMER DISEASE EVAL, ADDL CSF, ADEVL","code_information":[{"code":"3003154","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1796.0,"discounted_cash":1077.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ALPHA-2 PLASMIN INHIBITOR, A2PI","code_information":[{"code":"3003155","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85410","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COVID-19 AB, IGG, COR2G, VCOV2","code_information":[{"code":"3003157","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":32.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRUCELLA ANTIBODY, IGM BRCMG","code_information":[{"code":"3003158","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRUCELLA ANTIBODY, IGG BRCMG","code_information":[{"code":"3003159","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTIBODY, NIFTS","code_information":[{"code":"3003160","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, IG5TS","code_information":[{"code":"3003161","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, IG5TC","code_information":[{"code":"3003162","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, NIFTC","code_information":[{"code":"3003163","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AINCS","code_information":[{"code":"3003164","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, IG5CS","code_information":[{"code":"3003165","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, NFHCS","code_information":[{"code":"3003166","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, NFLCS","code_information":[{"code":"3003167","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AINCC","code_information":[{"code":"3003168","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, IG5CC","code_information":[{"code":"3003169","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, NFHCC","code_information":[{"code":"3003170","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, NFLCC","code_information":[{"code":"3003171","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AGNBS","code_information":[{"code":"3003172","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AMIBS","code_information":[{"code":"3003173","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AN1BS","code_information":[{"code":"3003174","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AN2BS","code_information":[{"code":"3003175","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, PC1BS","code_information":[{"code":"3003176","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, PCTBS","code_information":[{"code":"3003177","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AGNBC","code_information":[{"code":"3003178","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AMIBC","code_information":[{"code":"3003179","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AN1BC","code_information":[{"code":"3003180","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, AN2BC","code_information":[{"code":"3003181","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, PC1BC","code_information":[{"code":"3003182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY, PCTBC","code_information":[{"code":"3003183","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSF 87635 SARS-COV-2 RNA RT PCR, COVID 19","code_information":[{"code":"3003184","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSF 86769 COVID 19 AB IGG","code_information":[{"code":"3003185","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO 87635 COVID PCR NON MAYO","code_information":[{"code":"3003187","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOT FACTOR VIII VW RISTOCTN, RIST","code_information":[{"code":"3003188","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EUGLOBULIN LYSIS, FECLT","code_information":[{"code":"3003189","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MUTATION ANALY, NPM1Q","code_information":[{"code":"3003190","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":942.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WBC ANTIBODY IDENTIFICATION, LAGGT","code_information":[{"code":"3003191","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":184.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VW CLOTTING FUNCT ACTIVITY, VWACT","code_information":[{"code":"3003192","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RESPIRATORY PATHOGEN ARRAY","code_information":[{"code":"3003194","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1250.0,"discounted_cash":750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROM F8 ACT, CH8","code_information":[{"code":"3003195","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRAMADOL, TRAM","code_information":[{"code":"3003196","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GABAPENTIN, URINE, FGABA","code_information":[{"code":"3003197","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOKINE PANEL 13, INT'L, FCYTP","code_information":[{"code":"3003198","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOKINE PANEL 13, ADD'L, FCYTP","code_information":[{"code":"3003199","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX F8 BETHESDA, 8BETH","code_information":[{"code":"3003200","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VW FACTOR AG, AVWPR","code_information":[{"code":"3003201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":217.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOT FACTOR VIII, AVWPR","code_information":[{"code":"3003202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VW FACTOR ACTIVITY, AVWPR","code_information":[{"code":"3003203","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":278.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX VW FACTOR MULTIMER, VWFMP","code_information":[{"code":"3003204","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":175.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MS PROFILE, MSP3","code_information":[{"code":"3003205","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC KRAS GENE EXON 3&4","code_information":[{"code":"3003206","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":781.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CSF OLIGOCLONAL BANDS, OLIGC","code_information":[{"code":"3003207","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THIOPURINES AND METABOLITES, THIO","code_information":[{"code":"3003208","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.0,"discounted_cash":714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX SERUM OLIGOCLONAL BANDS, OLIGS","code_information":[{"code":"3003209","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FETAL CHRMOML ANEUPLOIDY, FMT21","code_information":[{"code":"3003210","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81420","type":"HCPCS"}],"standard_charges":[{"gross_charge":4310.0,"discounted_cash":2586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEV IGG, HEVG","code_information":[{"code":"3003211","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEV IGM CONFIRM, HEVML","code_information":[{"code":"3003212","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HSV CULTURE NEONAT INT'L, VHSV","code_information":[{"code":"3003213","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HSV CULTURE NEONAT ADD'L, VHSV","code_information":[{"code":"3003214","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87254","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PSYCHOSINE, RBC, PSYR","code_information":[{"code":"3003215","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GALACTOCEREBROSIDASE, WBC, GALCW","code_information":[{"code":"3003216","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":2248.0,"discounted_cash":1348.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ADENOVIRUS PCR, LADV","code_information":[{"code":"3003217","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC EGFR GENE COM VARIANTS","code_information":[{"code":"3003218","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PANCREATIC ELASTASE FECES, ELASF","code_information":[{"code":"3003224","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":243.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC HEP B SURFACE AG CONF, HEPBCONF","code_information":[{"code":"3003225","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 87426 CORONAVIRUS AG FIA","code_information":[{"code":"3003230","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"HC REFLEX C DIFF QUIK CHEK","code_information":[{"code":"3003231","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CSF TAU, PRION","code_information":[{"code":"3003234","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROTEIN 14-3-3 WESTERN BLOT, PRION","code_information":[{"code":"3003235","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURO CSF PRION PRTN QUAL, PRION","code_information":[{"code":"3003236","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2430.0,"discounted_cash":1458.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOT FACTOR X STUART-POWER, FXCH","code_information":[{"code":"3003237","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO RELFEX GAMMA GLOBIN FULL GENE SEQ, WGSQR","code_information":[{"code":"3003239","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.0,"discounted_cash":1009.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX BETA GLOBIN CLUSTER LOCUS DEL/DEP, WBDDR","code_information":[{"code":"3003240","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81363","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":942.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX BETA GLOBIN GENE SEQUENCE, WBSQR","code_information":[{"code":"3003241","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81364","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.0,"discounted_cash":1009.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ALPHA GLOBIN GENE SEQUENCE, WASQR","code_information":[{"code":"3003242","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81259","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.0,"discounted_cash":1009.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX UNSTABLE HEMOGLOBIN, UNHB","code_information":[{"code":"3003243","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":461.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX HB VAR MASS SPEC, MASS","code_information":[{"code":"3003244","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ELECTROPHORESIS CONFIRM, IEF","code_information":[{"code":"3003245","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX HGB SICKLE, SDEX","code_information":[{"code":"3003246","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, HBELC, LC 121690","code_information":[{"code":"3003247","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HGB A2/F, HBELC","code_information":[{"code":"3003248","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO USTEKINUMAB QUANT ASSAY DRUG, USTEK","code_information":[{"code":"3003250","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":398.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO USTEKINUMAB AB QUANT, USTEK","code_information":[{"code":"3003251","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MUCOPOLYSACCHARIDES, MPSQU","code_information":[{"code":"3003252","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":796.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE CREATININE, MPSQU","code_information":[{"code":"3003253","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIMULLERIAN HORMONE, AMH1","code_information":[{"code":"3003256","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURON SPECIFIC ENOLASE, CSF, NSESF","code_information":[{"code":"3003257","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX JAK2 EXON 12-15 SEQ, PVJAK","code_information":[{"code":"3003258","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.0,"discounted_cash":672.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WEST NILE VIRUS PCR, WNVP","code_information":[{"code":"3003259","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX SRP IMMUNOBLOT, SRPBS","code_information":[{"code":"3003260","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.0,"discounted_cash":282.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SRP FLUORESCENT ANTIBODY SCREEN, NMS1","code_information":[{"code":"3003261","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HMG-COA REDUCTASE AB, NMS1","code_information":[{"code":"3003262","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASPERGILLUS FUMIGATUS ANTIBODY, SASP","code_information":[{"code":"3003263","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DEXAMETHASONE, FDXM","code_information":[{"code":"3003264","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":332.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MAGNESIUM RANDOM URINE, MAGNR","code_information":[{"code":"3003265","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASPERGILLUS FUMIGATUS IGG ANTIBODY, HYPS","code_information":[{"code":"3003266","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THERMOACTINOMYCES VUL IGG, HYPS","code_information":[{"code":"3003267","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MICROPOLYSPORA FAENI IGG, HYPS","code_information":[{"code":"3003268","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO URINE ARSENIC SPECIATION, SPAS","code_information":[{"code":"3003269","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX SRP IMMUNOFLUORESCENT AB TITER, SRPTS","code_information":[{"code":"3003270","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":565.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO KIT GENE ANALYSIS D816 VARIANT, KITVS, KITQ","code_information":[{"code":"3003271","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81273","type":"HCPCS"}],"standard_charges":[{"gross_charge":2356.0,"discounted_cash":1413.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE CREATININE, HMUOE","code_information":[{"code":"3003272","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE ARSENIC, HMUOE","code_information":[{"code":"3003273","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE CADMIUM, HMUOE","code_information":[{"code":"3003274","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE MERCURY, HMUOE","code_information":[{"code":"3003275","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE LEAD, HMUOE","code_information":[{"code":"3003276","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ARSENIC 24HR URINE, SPASU","code_information":[{"code":"3003277","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE CREATININE, CDUOE","code_information":[{"code":"3003278","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO URINE CADMIUM, CDUOE","code_information":[{"code":"3003279","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HLA I TYPING COMPLETE LR IN'L, 1DIS","code_information":[{"code":"3003288","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HLA I TYPING COMPLETE LR, ADD'L, 1DIS","code_information":[{"code":"3003289","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":320.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO RIA NONANTIBODY, INT'L, MAS1","code_information":[{"code":"3003290","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HD SO RIA NONANTIBODY ADD'L, MAS1","code_information":[{"code":"3003291","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":330.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ISLET CELL ANTIBODY, MAS1","code_information":[{"code":"3003292","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":423.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN INITIAL, MAS1","code_information":[{"code":"3003293","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN ADD'L, MAS1","code_information":[{"code":"3003294","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PROTEIN WESTERN BLOT TEST, MAS1, SRPBS","code_information":[{"code":"3003295","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF MYOGLOBIN, MYGLU","code_information":[{"code":"3003298","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOKINE PANEL, INTL, CYPAN","code_information":[{"code":"3003299","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOKINE PANEL, ADDL, CYPAN","code_information":[{"code":"3003300","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO BENZO CONF RAND UR, BNZU","code_information":[{"code":"3003301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG ASSAY AMIODARONE","code_information":[{"code":"3003305","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80151","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY CARBAMAZEPIN 10,11-EPXID","code_information":[{"code":"3003306","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80161","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY CARBAMAZEPIN 10,11-EPXID","code_information":[{"code":"3003307","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG ASSAY FELBAMATE","code_information":[{"code":"3003308","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80167","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG ASSAY ITRACONZAOLE","code_information":[{"code":"3003309","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80189","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG ASSAY LEFLUNOMIDE","code_information":[{"code":"3003310","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG ASSAY RUFINAMIDE","code_information":[{"code":"3003311","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80210","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEREDITARY BREAST/COLON PANEL","code_information":[{"code":"3003312","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81351","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":673.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TP53 GENE SOMATIC MUTATION ANALYSIS","code_information":[{"code":"3003313","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.0,"discounted_cash":1009.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRUG ASSAY SALICYLATE","code_information":[{"code":"3003314","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":284.0,"discounted_cash":170.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG ASSAY ACETAMINOPHEN","code_information":[{"code":"3003315","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":414.0,"discounted_cash":248.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DRUG ASSAY METHOTREXATE","code_information":[{"code":"3003316","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":320.0,"discounted_cash":192.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ETHYL ALCOHOL (ETHANOL)","code_information":[{"code":"3003317","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":392.0,"discounted_cash":235.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO REFLEX IMMUNOFIX E-PHORESIS CRYOGLOBULIN, IMFXC","code_information":[{"code":"3003318","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHENOTYPE INFECT AGENT, HIV-1","code_information":[{"code":"3003319","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":664.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GENOTYPE DNA HIV REVERSE T, HIV-1","code_information":[{"code":"3003320","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":664.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV INTEGRASE GENOTYPE, HIV1","code_information":[{"code":"3003321","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":1682.0,"discounted_cash":1009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF SEX HORM BINDING GLOBUL, SHBG1","code_information":[{"code":"3003322","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF CRYOGLOBULIN, CRGSP","code_information":[{"code":"3003323","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF CRYOFIBRINOGEN, CRGSP","code_information":[{"code":"3003324","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82585","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACYLGLYCINES QN U, AGU20","code_information":[{"code":"3003327","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":345.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MECONIUM 14 PAN TOXI, USDTL","code_information":[{"code":"3003328","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"discounted_cash":485.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UMB CORD 14 TOXI, USDTL","code_information":[{"code":"3003329","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":498.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DPYD GENE SEQUENCING, DPYDG","code_information":[{"code":"3003330","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":2661.0,"discounted_cash":1596.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OPIOID, CSMPU","code_information":[{"code":"3003331","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BENZODIAZEPINES, CSMPU","code_information":[{"code":"3003332","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PRSMV DRUG SCREEN, CSMPU","code_information":[{"code":"3003333","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMPHETAMINES, CSMPU","code_information":[{"code":"3003334","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF G6PD ENZYME, G6PD1","code_information":[{"code":"3003335","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MURAMIDASE, MURA","code_information":[{"code":"3003336","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF PYRUVATE KINASE, PK1","code_information":[{"code":"3003337","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84220","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLACTOSEMIA, FULL GENE ANALYSIS, GALZ","code_information":[{"code":"3003341","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4935.0,"discounted_cash":2961.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EPSTEIN-BARR VIRUS PCR, FEBVP","code_information":[{"code":"3003342","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":472.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GALACTOSE ALPHA 1, 3 GALACTOSE ALLERGEN, ALGAL","code_information":[{"code":"3003344","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGENS MEAT PROFILE INTL, APGAL","code_information":[{"code":"3003345","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGENS MEAT PROFILE ADDL, APGAL","code_information":[{"code":"3003346","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ASSAY PH BODY FLUID, FPEPA","code_information":[{"code":"3003347","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF PROTEIN OTHER, FPEPA","code_information":[{"code":"3003348","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NON-ANTIBODY, FPEPA","code_information":[{"code":"3003349","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MPL EXON 10 MUTATION DETECTION, MPLVS","code_information":[{"code":"3003350","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81339","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.0,"discounted_cash":829.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX GAMMA GLOB GENE SEQ, WGSQR","code_information":[{"code":"3003353","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.0,"discounted_cash":958.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX BETA GLOB CLUSTER LOCUS, WBDDR","code_information":[{"code":"3003354","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81363","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.0,"discounted_cash":894.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX BETA GLOBIN GENE SEQUENCE, WBSQR","code_information":[{"code":"3003355","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81364","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.0,"discounted_cash":958.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX HEMOGLOBIN STABILITY SCR, UNHB","code_information":[{"code":"3003356","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ISOELECTRIC FOCUS CONF, IEF","code_information":[{"code":"3003357","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82664","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX HBG VARIANT MASS SPECT, MASS","code_information":[{"code":"3003358","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX RBC SICKLE CELL TEST, SDEX","code_information":[{"code":"3003359","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COMPLEMENT ANTIGEN, (C4), FC4AL","code_information":[{"code":"3003360","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":609.0,"discounted_cash":365.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE CREATININE, CRUO","code_information":[{"code":"3003361","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF CHROMIUM, CRUO","code_information":[{"code":"3003362","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.0,"discounted_cash":275.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ACHR MOD FLOW CYTO, ACMFS","code_information":[{"code":"3003363","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, HBEL1","code_information":[{"code":"3003365","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"discounted_cash":485.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE PHOSPHORUS, RPHOC","code_information":[{"code":"3003366","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE CREATININE, MAGRU","code_information":[{"code":"3003367","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE MAGNESIUM, MAGRU","code_information":[{"code":"3003368","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CSF MENINGITIS ENCEPHALITIS PCR, CSFME","code_information":[{"code":"3003369","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.0,"discounted_cash":766.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ACH MUSC BIND MUSK AB, MGMR","code_information":[{"code":"3003370","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEP MUSCLE BINDING AB, MGLE","code_information":[{"code":"3003371","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO P/Q TYPE CALCIUM CHANNEL AB, MGLE","code_information":[{"code":"3003372","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SARSCOV & INF VIR A&B AG IA","code_information":[{"code":"3003373","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87428","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":276.6,"setting":"both","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"HC SO STRONGYLOIDES AB IGG, STRNG","code_information":[{"code":"3003374","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF BIOTIN, BIOTN","code_information":[{"code":"3003375","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF FERRITIN, THEV1","code_information":[{"code":"3003376","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THALASSEMIA AND HEMOGLOB INTL, THEV1","code_information":[{"code":"3003377","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THALASSEMIA AND HEMOGLOB ADDL, THEV1","code_information":[{"code":"3003378","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HEMOGLOBIN CHROMOTOGRAPHY, THEV1","code_information":[{"code":"3003379","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY INTL, FMYO3","code_information":[{"code":"3003380","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTIBODY ADDTL, FMYO3","code_information":[{"code":"3003381","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NUCLEAR AG AB, INTL, FMYO3, MSAES","code_information":[{"code":"3003382","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NUCLEAR AG AB ADDL, FMYO3","code_information":[{"code":"3003383","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO EHLERS DANLOS GENE PANEL INTL, EDSGP","code_information":[{"code":"3003384","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":5455.0,"discounted_cash":3273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHLERS DANLOS GENE PANEL ADDL, EDSGP","code_information":[{"code":"3003385","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":5455.0,"discounted_cash":3273.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PHOSPHATIDYLETHANOL, FFPET","code_information":[{"code":"3003386","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYSTATIN C W ESTIMATED GFR, CSTCE","code_information":[{"code":"3003387","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GAMMAGLOBULIN INTL, CSF IGG PROF, SFIG","code_information":[{"code":"3003388","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GAMMAGLOBULIN ADDL, CSF IGG PROF, SFIG","code_information":[{"code":"3003389","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":27.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ALBUMIN QUAN EA CSF, SFIG","code_information":[{"code":"3003390","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":23.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF SERUM ALBUMIN, SFIG","code_information":[{"code":"3003391","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WEST NILE VIRUS RNA, PCR, WNVS","code_information":[{"code":"3003392","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO METHYLPHENIDATE, MPHNU","code_information":[{"code":"3003393","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":329.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROMOGENIC F8 SUBSTRATE ASSAY, CFH8","code_information":[{"code":"3003394","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IFNL3 GENE ANALYSIS, IL28Q","code_information":[{"code":"3003395","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.0,"discounted_cash":894.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYP2C19 GENE COM VARIANTS, 2C19R","code_information":[{"code":"3003396","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2555.0,"discounted_cash":1533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HLA I TYPING 1 ALLELE HR, HL57R","code_information":[{"code":"3003397","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TPMT NUDT15 GENES, TPNUQ","code_information":[{"code":"3003398","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0034U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1491.0,"discounted_cash":894.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BLASTOMYCES AG QUANT EIA, UBLAS","code_information":[{"code":"3003399","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":304.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SACCHAROMYCES CEREVISIAE AB IGA, IBDP2","code_information":[{"code":"3003400","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN, IBDP2","code_information":[{"code":"3003401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":28.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SACCHAROMYCES CEREVISIAE AB IGG, IBDP2","code_information":[{"code":"3003402","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":28.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO SACCHAROMYCES CEREVISIAE AB IGA, SCERA","code_information":[{"code":"3003403","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SACCHAROMYCES CEREVISIAE AB IGG, SCERG","code_information":[{"code":"3003404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DISACCHARIDASE ACTIVITY PANEL, DSAC","code_information":[{"code":"3003405","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CNT PANEL, CEP72","code_information":[{"code":"3003406","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":994.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOPHILUS INFLUENZA AB, HIBS","code_information":[{"code":"3003407","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86684","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BLOOD VISCOSITY SERUM, SVISC","code_information":[{"code":"3003408","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FACTOR INHIBITOR TEST, CHF8P","code_information":[{"code":"3003409","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1498.0,"discounted_cash":898.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROMOGENIC SUBSTRATE ASSAY, CHF8P","code_information":[{"code":"3003410","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1426.0,"discounted_cash":855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BKV DNA DETECT/QUANT, PBKQN","code_information":[{"code":"3003411","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EBV DNA DETECT/QUANT, EBVQN","code_information":[{"code":"3003412","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BK VIRUS DNA DETECT/QUANT, UBKQN","code_information":[{"code":"3003413","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EUGLOBULIN CLOT LYSIS TIME, FEUCT","code_information":[{"code":"3003414","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85360","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO 83516 MAG IGM, MAGES","code_information":[{"code":"3003415","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTOPLASMA CAPSUL AG IA, HSTQU","code_information":[{"code":"3003416","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO RESP VIRUS 12-25 TARGETS, RESLR, RPB","code_information":[{"code":"3003417","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":715.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DETECT AGENT NOS DNA AMP, RESLR","code_information":[{"code":"3003418","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO M PNEUMON DNA AMP PROBE, RESLR","code_information":[{"code":"3003419","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHYLMD PNEUM DNA AMP PROBE. RESLR","code_information":[{"code":"3003420","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87486","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HMG COA REDUCTASE AB, HMGCR","code_information":[{"code":"3003421","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":332.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCREEN 10 PANEL, FD10S","code_information":[{"code":"3003422","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX AMPHETAMINES 5 OR MORE, FAMCS","code_information":[{"code":"3003423","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":135.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX METHYLENEDIOXYAMPHETAMINES, FAMCS","code_information":[{"code":"3003424","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG SCREENING BARBITURATES, FBBCS","code_information":[{"code":"3003425","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":507.0,"discounted_cash":304.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX BENZODIAZEPINES 13 OR MORE, FBCS","code_information":[{"code":"3003426","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFELX CANNABINOIDS, FCANS","code_information":[{"code":"3003427","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":276.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX DRUG SCREENING COCAINE, FCMC","code_information":[{"code":"3003428","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":266.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX DRUG SCREENING METHADONE, FMMCS","code_information":[{"code":"3003429","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.0,"discounted_cash":302.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX HEROIN METABOLITE, FOFU","code_information":[{"code":"3003430","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80356","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX OPIATES 1 OR MORE, FOFU","code_information":[{"code":"3003431","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX DRUG SCREENING OXYCODONE, FOFU","code_information":[{"code":"3003432","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX PHENCYCLIDINE CONF, FPCCS","code_information":[{"code":"3003433","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":334.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HAEMOPHILUS INFLUENZA B AB IGG, HIBSG","code_information":[{"code":"3003434","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86684","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO 83789 HEAVY METAL, QUANTIFICATION, EA; UIOD","code_information":[{"code":"3003436","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO 83520 MAG IGM, MAGES","code_information":[{"code":"3003437","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CITRIC ACID 24H URINE W/CREAT, FCA24","code_information":[{"code":"3003438","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HSV 1 DNA AMP PROBE, FHS12","code_information":[{"code":"3003439","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HSV 2 DNA AMP PROBE, FHS12","code_information":[{"code":"3003440","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PMS2 GENE DUP/DELET VARIANTS, LYNCP","code_information":[{"code":"3003441","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81319","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.0,"discounted_cash":573.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 4, LYNCP","code_information":[{"code":"3003442","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MLH1 GENE FULL SEQ, LYNCP","code_information":[{"code":"3003443","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81292","type":"HCPCS"}],"standard_charges":[{"gross_charge":3170.0,"discounted_cash":1902.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MSH2 GENE FULL SEQ, LYNCP","code_information":[{"code":"3003444","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81295","type":"HCPCS"}],"standard_charges":[{"gross_charge":1791.0,"discounted_cash":1074.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MSH6 GENE FULL SEQ, LYNCP","code_information":[{"code":"3003445","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81298","type":"HCPCS"}],"standard_charges":[{"gross_charge":3011.0,"discounted_cash":1806.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PTEN GENE FULL SEQUENCE, PTNZ","code_information":[{"code":"3003446","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81321","type":"HCPCS"}],"standard_charges":[{"gross_charge":6812.0,"discounted_cash":4087.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 7, RETZZ","code_information":[{"code":"3003447","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":6812.0,"discounted_cash":4087.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TESTOSTERONE BIOAVAILABLE, FFTST","code_information":[{"code":"3003448","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY FREE TESTOSTERONE","code_information":[{"code":"3003449","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF TOTAL TESTOSTERONE, FFTFT","code_information":[{"code":"3003450","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VDSFQ SYPHILIS REFLEX, VDSFQ, VDSFT","code_information":[{"code":"3003451","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":47.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VDRL CSF SYPHILIS TEST, VDRL","code_information":[{"code":"3003452","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":25.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO RESP PANEL BRONCH PCR, RPB","code_information":[{"code":"3003453","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":805.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROTEIN C TOTAL ANTIGEN, FPCTA","code_information":[{"code":"3003454","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MYCOBACTERIC ID, CTBID","code_information":[{"code":"3003455","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GONORRHOEAE AMP PROBE, CGRNA","code_information":[{"code":"3003456","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA AMP PROBE, CGRNA","code_information":[{"code":"3003457","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SYNTHETIC GLUCOCOR DRUG ASSAY, SGSS","code_information":[{"code":"3003458","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1499.0,"discounted_cash":899.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SARS-COV-2 COVID-19 AB, COVSQ","code_information":[{"code":"3003459","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEP MUSCLE BINDING AB, MGLE","code_information":[{"code":"3003461","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VOLTAGE-GATED CALCIUM CHANNEL, MGLE","code_information":[{"code":"3003462","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, MAS1","code_information":[{"code":"3003463","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AQUAPORIN-4 AB FLOW CYTO EA, MAS1","code_information":[{"code":"3003464","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROTEIN WESTERN BLOT TEST, MAS1","code_information":[{"code":"3003465","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOG-IGG1 ANTB FLO CYTMTRY EA, MAS1","code_information":[{"code":"3003466","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86363","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ISLET CELL ANTIBODY, MAS1","code_information":[{"code":"3003467","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":464.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, MAS1","code_information":[{"code":"3003468","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":237.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PANCREATIC ELASTASE FECES, ELASF","code_information":[{"code":"3003469","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INTERLEUKIN 6 P, IL6","code_information":[{"code":"3003470","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DETECT AGENT NOS DNA QUANT, FJCQP","code_information":[{"code":"3003471","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":1482.0,"discounted_cash":889.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX NMOFC","code_information":[{"code":"3003472","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1256.0,"discounted_cash":753.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANCA SCREEN EACH ANTIBODY, IBDP2","code_information":[{"code":"3003473","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":28.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ELASTASE PANCREATIC FECAL QUANTITATIVE","code_information":[{"code":"3003474","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":187.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGEN NEO MICRORA ALYS FFPE, CMAPT","code_information":[{"code":"3003484","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81277","type":"HCPCS"}],"standard_charges":[{"gross_charge":8942.0,"discounted_cash":5365.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IDH1 COMMON VARIANTS, IDH12","code_information":[{"code":"3003485","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IDH2 COMMON VARIANTS, IDH12","code_information":[{"code":"3003486","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":927.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURO ONC EXPANDED PANEL, NONCP","code_information":[{"code":"3003487","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":5988.0,"discounted_cash":3592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROMOTER METHYLATION TUMOR, MGMT","code_information":[{"code":"3003488","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81287","type":"HCPCS"}],"standard_charges":[{"gross_charge":1704.0,"discounted_cash":1022.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DEXAMETHASONE, DEXA","code_information":[{"code":"3003491","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TICKBORNE DNA PANEL, TKPNL","code_information":[{"code":"3003492","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TICKBORNE DNA PANEL ADD'L, TKPNL","code_information":[{"code":"3003493","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO TISSUE CULTURE LYMPHOCYTE, CHRCB","code_information":[{"code":"3003494","type":"CDM"},{"code":"0300","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":574.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HERPES SIMPLEX VIRUS,AMPLIFIED PROBE INITIAL, LHSV","code_information":[{"code":"3003495","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GI PATHOGEN ARRAY","code_information":[{"code":"3003496","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1952.0,"discounted_cash":1171.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENZYME IMMUNOASSAY NPDPSC, PRION","code_information":[{"code":"3003497","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STREP A, DNA, AMPLIFIED PROBE, PCR","code_information":[{"code":"3003498","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SEROTONIN RELEASE ASSAY, SRAU","code_information":[{"code":"3003502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBRINOGEN ANTIGEN, FIBAG","code_information":[{"code":"3003503","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN, PLA2R","code_information":[{"code":"3003504","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":358.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS NONAB, PLA2R","code_information":[{"code":"3003505","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":514.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COPPER ASSAY, CUS1","code_information":[{"code":"3003506","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ZINC ASSAY, ZN_S","code_information":[{"code":"3003507","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOCHROMATOSIS GENE ANALYSIS, HFET","code_information":[{"code":"3003508","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROTOPORPHYRINS, PPFE","code_information":[{"code":"3003509","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":532.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MITOCHONDRIAL (M2) EACH","code_information":[{"code":"3003534","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":58.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIRST TRIMESTER MATERNAL SCREEN, 1STT1","code_information":[{"code":"3003537","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81508","type":"HCPCS"}],"standard_charges":[{"gross_charge":839.0,"discounted_cash":503.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MONKEYPOX VIRUS, MPXDX","code_information":[{"code":"3003538","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":211.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NOTCH3 FULL GENE ANALYSIS MOLEC, NTC3Z","code_information":[{"code":"3003539","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":7859.0,"discounted_cash":4715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FULL GENE ANALYSIS MOLECULAR, CASRG","code_information":[{"code":"3003540","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":5993.0,"discounted_cash":3595.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CFTR GENE COM VARIANTS, CFMP","code_information":[{"code":"3003541","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":396.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CFTR GENE DUP/DELET VARIANTS, CFMP","code_information":[{"code":"3003542","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81222","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":310.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GALACTOSEMIA GALT GENE MOLECULAR, GALMP","code_information":[{"code":"3003543","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1867.0,"discounted_cash":1120.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TP53 GENE ANALYSIS, P53CA","code_information":[{"code":"3003544","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":883.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FENTANYL CONFIRM, FF10S","code_information":[{"code":"3003545","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PRIM MEMBRANOUS NEPHROPATHY DIAG, PMND1","code_information":[{"code":"3003546","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":593.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOFLUORESCENCE, PLA2I","code_information":[{"code":"3003547","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":593.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THROMBOSPONDIN TYPE 1 DOMAIN 7A, THSD7","code_information":[{"code":"3003548","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1367.0,"discounted_cash":820.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHOSPHOLIPASE A2 RECEPTOR MONITOR, PLA2M","code_information":[{"code":"3003549","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":989.0,"discounted_cash":593.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV1 RNA DETECT/QUANT, HIVQN","code_information":[{"code":"3003550","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":199.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO C1 ESTERASE INHIBITOR, C1INF","code_information":[{"code":"3003551","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PNEUMOCYSTIS PCR, PNRP","code_information":[{"code":"3003552","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LIPASE BF, LPSBF","code_information":[{"code":"3003553","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INTERLEUKIN 2 RECEPTOR, FIL2S","code_information":[{"code":"3003554","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHOSPHATIDYLETHANOL CONF, PETH","code_information":[{"code":"3003555","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CULTURE AEROBIC ID, IDENT","code_information":[{"code":"3003556","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":74.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CULTURE ANAEROBE ID EACH, ANIDE","code_information":[{"code":"3003557","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HRDTRY PERPH NEURPHY PANEL, PEPAN","code_information":[{"code":"3003559","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81448","type":"HCPCS"}],"standard_charges":[{"gross_charge":11788.0,"discounted_cash":7072.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SENSORY NEURPHY PANEL, ISNP","code_information":[{"code":"3003560","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81448","type":"HCPCS"}],"standard_charges":[{"gross_charge":9824.0,"discounted_cash":5894.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UNLISTED MOLECULAR PATHOLOGY, SEP9Z","code_information":[{"code":"3003561","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":7859.0,"discounted_cash":4715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HRDTRY PERPH NEURPHY PANEL, ISPP","code_information":[{"code":"3003562","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81448","type":"HCPCS"}],"standard_charges":[{"gross_charge":9824.0,"discounted_cash":5894.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOTOR AND SENS NEURO PANEL, IMSNP","code_information":[{"code":"3003563","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81448","type":"HCPCS"}],"standard_charges":[{"gross_charge":9824.0,"discounted_cash":5894.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE SODIUM, SUP24","code_information":[{"code":"3003564","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE POTASSIUM, SUP24","code_information":[{"code":"3003565","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF CALCIUM IN URINE, SUP24","code_information":[{"code":"3003566","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE MAGNESIUM, SUP24","code_information":[{"code":"3003567","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE CHLORIDE, SUP24","code_information":[{"code":"3003568","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE PHOSPHORUS, SUP24","code_information":[{"code":"3003569","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE SULFATE, SUP24","code_information":[{"code":"3003570","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF CITRATE, SUP24","code_information":[{"code":"3003571","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE OXALATE, SUP24","code_information":[{"code":"3003572","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY URINE PH, SUP24","code_information":[{"code":"3003573","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE URIC ACID, SUP24","code_information":[{"code":"3003574","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE CREATININE, SUP24","code_information":[{"code":"3003575","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE OSMOLALITY, SUP24","code_information":[{"code":"3003576","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE AMMONIA, SUP24","code_information":[{"code":"3003577","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF URINE UREA-N, SUP24","code_information":[{"code":"3003578","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROC LEVEL 4, LQTSG","code_information":[{"code":"3003579","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":464.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROC LEVEL 7 INIT, LQTSG","code_information":[{"code":"3003580","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1183.0,"discounted_cash":709.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROC LEVEL 7 ADDL, LQTSG","code_information":[{"code":"3003581","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1183.0,"discounted_cash":709.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH PROC LEVEL 8, LQTSG","code_information":[{"code":"3003582","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":3539.0,"discounted_cash":2123.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MARFAN PLUS PANEL, MFRGG","code_information":[{"code":"3003583","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81410","type":"HCPCS"}],"standard_charges":[{"gross_charge":7073.0,"discounted_cash":4243.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NOONAN SPECTRUM DISORDERS, NSRGG","code_information":[{"code":"3003584","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81442","type":"HCPCS"}],"standard_charges":[{"gross_charge":6287.0,"discounted_cash":3772.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HRDTRY CARDMYPY GENE PANEL, HCMGG","code_information":[{"code":"3003585","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81439","type":"HCPCS"}],"standard_charges":[{"gross_charge":7270.0,"discounted_cash":4362.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HHT VASCULAR GENE PANEL INIT, HHTGG","code_information":[{"code":"3003586","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2619.0,"discounted_cash":1571.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HHT VASCULAR GENE PANEL ADD'L, HHTGG","code_information":[{"code":"3003587","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2619.0,"discounted_cash":1571.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO BRUGADA SYNDROME FULL GENE, SCN5A","code_information":[{"code":"3003588","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":8841.0,"discounted_cash":5304.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HRDTRY CARDMYPY GENE PANEL, CCMGG","code_information":[{"code":"3003589","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81439","type":"HCPCS"}],"standard_charges":[{"gross_charge":7466.0,"discounted_cash":4479.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH FBN1 FULL GENE ANALYSIS, MFBNG","code_information":[{"code":"3003590","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":6287.0,"discounted_cash":3772.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TARGETED GENOMIC SEQ ANALYS","code_information":[{"code":"3003591","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":5046.0,"discounted_cash":3027.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHLERS-DANLOS GENE PANEL INIT, EDSGG","code_information":[{"code":"3003592","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":3733.0,"discounted_cash":2239.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHLERS-DANLOS GENE PANEL ADD'L, EDSGG","code_information":[{"code":"3003593","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":3733.0,"discounted_cash":2239.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 5, IMNP","code_information":[{"code":"3003594","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.0,"discounted_cash":1143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 5 ADD'L, IMNP","code_information":[{"code":"3003595","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.0,"discounted_cash":1143.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 6, IMNP","code_information":[{"code":"3003596","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2089.0,"discounted_cash":1253.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 7, IMNP","code_information":[{"code":"3003597","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":1176.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 7 ADD'L, IMNP","code_information":[{"code":"3003598","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":1176.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO TICKBORNE DNA PANEL INIT'L, TIKLB","code_information":[{"code":"3003599","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TICKBORNE DNA PANEL ADD'L, TIKLB","code_information":[{"code":"3003600","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":37.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO B BURGDORFERI AMP, LYMPV","code_information":[{"code":"3003601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHIA/ANAPLASMA INIT'L, LYMPV","code_information":[{"code":"3003602","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":55.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHIA/ANAPLASMA ADD'L, LYMPV","code_information":[{"code":"3003603","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":55.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOMEGALOVIRUS PCR, CMVPV","code_information":[{"code":"3003604","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VARICELLA ZOSTER PCR, VZVPV","code_information":[{"code":"3003605","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HSV PCR B INITIAL, HSVPB","code_information":[{"code":"3003606","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HSV PCR B ADD'L, HSVPB","code_information":[{"code":"3003607","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO EHRLICHIA/ANAPLASMA PCR B INIT'L, EPCRB","code_information":[{"code":"3003608","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHIA/ANAPLASMA PCR B ADD'L, EPCRB","code_information":[{"code":"3003609","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HSV PCR INIT'L, HSVPV","code_information":[{"code":"3003610","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HSV PCR ADD'L, HSVPV","code_information":[{"code":"3003611","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PLASMA FREE HEMOGLOBIN, PLHBB","code_information":[{"code":"3003612","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SAMC PLATELET AGG HKH MA PARAMETER","code_information":[{"code":"3003613","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SAMC PLATELET AGG ACTF MA PARAMETER","code_information":[{"code":"3003614","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SAMC PLATELET AGG ADP MA PARAMETER","code_information":[{"code":"3003615","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SAMC PLATELET AGG AA MA PARAMETER","code_information":[{"code":"3003616","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SAMC BLOOD PLATELET AGGREGATION","code_information":[{"code":"3003618","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":253.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CREATININE UR, CRCRU","code_information":[{"code":"3003619","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROMIUM URINE, CRCRU","code_information":[{"code":"3003620","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":234.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CREATININE UR, NIUCR","code_information":[{"code":"3003621","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":130.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NICKEL, NIUCR","code_information":[{"code":"3003622","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83885","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AGNA-1 TITER, AGNTS","code_information":[{"code":"3003623","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANNA-1 TITER, AN1TS","code_information":[{"code":"3003624","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANNA-2 TITER, AN2TS","code_information":[{"code":"3003625","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANNA-3 TITER, AN3TS","code_information":[{"code":"3003626","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CRMP-5-IGG TITER, CRMTS","code_information":[{"code":"3003627","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PCA-1 TITER, PC1TS","code_information":[{"code":"3003628","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PCA-2 TITER, PC2TS","code_information":[{"code":"3003629","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PCA-TR TITER, PCTTS","code_information":[{"code":"3003630","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEUROCHRONDRIN IFA TITER, NCDTS","code_information":[{"code":"3003631","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEUROCONDRIN CBA, NCDCS","code_information":[{"code":"3003632","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AP3B2 CBA, APBCS","code_information":[{"code":"3003633","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AP3B2 IFA TITER, APBTS","code_information":[{"code":"3003634","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SEPTIN-7 CBA, SP7CS","code_information":[{"code":"3003635","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SEPTIN-7 IFA TITER, SP7TS","code_information":[{"code":"3003636","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AGNA-1 TITER CSF, AGNTC","code_information":[{"code":"3003637","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANNA-1 TITER CSF, AN1TC","code_information":[{"code":"3003638","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANNA-2 TITER CSF, AN2TC","code_information":[{"code":"3003639","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANNA-3 TITER CSF, AN3TC","code_information":[{"code":"3003640","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMPHIPHYSIN AB TITER CSF, APHTC","code_information":[{"code":"3003641","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CRMP-5 IGG TITER CSF, CRMTC","code_information":[{"code":"3003642","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEUROCONDRIN CBA CSF, NCDCC","code_information":[{"code":"3003643","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEUROCHONDRIN IFA TITER CSF, NCDTC","code_information":[{"code":"3003644","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PCA-1 TITER CSF, PC1TC","code_information":[{"code":"3003645","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PCA-TR TITER CSF, PCTTC","code_information":[{"code":"3003646","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PCA-2 TITER CSF, PC2TC","code_information":[{"code":"3003647","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SEPTIN-7 CBA CSF, SP7CC","code_information":[{"code":"3003648","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1376.0,"discounted_cash":825.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SEPTIN-7 IFA TITER CSF, SP7TC","code_information":[{"code":"3003649","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MASS SPECTROMETRY QUAL/QUAN, REVE2","code_information":[{"code":"3003650","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":927.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, REVE2","code_information":[{"code":"3003651","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, REVE2","code_information":[{"code":"3003652","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":495.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HEMOGLOBIN CHROMOTOGRAPHY, REVE2","code_information":[{"code":"3003653","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1159.0,"discounted_cash":695.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INTERLEUKIN-6, IL6DX","code_information":[{"code":"3003654","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMPHIPHYSIN AB TITER, APHTS","code_information":[{"code":"3003655","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYST GLUCOSE BF NOT BLOOD, INTERPACE","code_information":[{"code":"3003656","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF BLOOD PKU, PKUBS","code_information":[{"code":"3003659","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF TYROSINE, PKUBS","code_information":[{"code":"3003660","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84510","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MVISTA HISTOPLASMA AG, FHIST","code_information":[{"code":"3003661","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":301.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HYDROXYPROGESTERONE 17-D, F17HY","code_information":[{"code":"3003662","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANDROSTENEDIONE, FANDR","code_information":[{"code":"3003663","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYSTIC FIBROSIS GENE ANALYSIS, HPANP","code_information":[{"code":"3003664","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":3631.0,"discounted_cash":2178.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH LEVEL 5 2-5 EXONS, HPANP","code_information":[{"code":"3003665","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.0,"discounted_cash":1200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH LEVEL 5 2-5 EXONS, HPANP","code_information":[{"code":"3003666","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":2000.0,"discounted_cash":1200.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH LEVEL 6 6-10 EXONS, HPANP","code_information":[{"code":"3003667","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2193.0,"discounted_cash":1315.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYSTIC FIBROSIS FULL GENE ANALYS, CFTRN","code_information":[{"code":"3003668","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":5109.0,"discounted_cash":3065.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTO/BLASTO AG EIA, HIBAG, UHBAG","code_information":[{"code":"3003669","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":368.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ZIKA VIRUS PCR, VZIKS","code_information":[{"code":"3003670","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87662","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA AB, CHLAP","code_information":[{"code":"3003671","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA AB, CHLAP","code_information":[{"code":"3003672","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":21.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CHLAMYDIA IGM, CHLAP","code_information":[{"code":"3003673","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA IGM, CHLAP","code_information":[{"code":"3003674","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":24.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CERAMIDE TRIHEX AND SULFATIDE, CTSU","code_information":[{"code":"3003675","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYCLIC CITRULL PEP AB, CCP","code_information":[{"code":"3003676","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENZYME CELL ACT, GRANGER GENE ASPARAGIN","code_information":[{"code":"3003677","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IA NONAB, GRANGER GENE ASPARAGIN","code_information":[{"code":"3003678","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOT INHIBIT PROTEIN S REFLEX, SFX","code_information":[{"code":"3003679","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEX LA DELTA REFLEX, HEXLA","code_information":[{"code":"3003680","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BARBITURATES, FBCFS","code_information":[{"code":"3003681","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MONKEYPOX VIRUS DNA QL PCR, FMPVP","code_information":[{"code":"3003682","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":131.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MONKEYPOX VIRUS DNA QL PCR ADD, FMPVP","code_information":[{"code":"3003683","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":131.4,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC SO CREATINE KINASE ISOENZYME REFLEX, CKELR","code_information":[{"code":"3003684","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":14.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CK ISOENZYME ELECTROPHOR, CKE","code_information":[{"code":"3003685","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NMDA AB TITER, NMDIS","code_information":[{"code":"3003686","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEPHELOMETRY NOS, BTPBF, BTP","code_information":[{"code":"3003689","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OVA AND PARASITE, OPE","code_information":[{"code":"3003690","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OVA AND PARASITE SMEAR, OPE","code_information":[{"code":"3003691","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TPMT ACTIV PROFILE, TPMT3","code_information":[{"code":"3003692","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF INTERLEUKIN-6, CYPAN","code_information":[{"code":"3003693","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GALACTOSE IGE, ALGAL","code_information":[{"code":"3003694","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC MYCOPLASMA PNEUM DNA MOL","code_information":[{"code":"3003695","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSY OF LACTIC ACID CSF, LASF1","code_information":[{"code":"3003697","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":24.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY INFECTIOUS AGENT INTL, PN23M","code_information":[{"code":"3003698","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY INFECTIOUS AGENT ADDL, PN23M","code_information":[{"code":"3003699","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO Q FEVER AB SCRN TITER REFLEX, QFEVR","code_information":[{"code":"3003700","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86638","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC TREPONEMA PALLIDUM","code_information":[{"code":"3003701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA AB, CHLG","code_information":[{"code":"3003702","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMPHETAMINES 3 OR 4, AMPHU","code_information":[{"code":"3003707","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OPIOIDS & OPIATE ANALOGS, OPATU","code_information":[{"code":"3003708","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80362","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CNS DEMYELINATING DISEASE 86053, CDS1","code_information":[{"code":"3003709","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CNS DEMYELINATING DISEASE 86363, CDS1","code_information":[{"code":"3003710","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86363","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF INTERLEUKIN 6, FCYTP","code_information":[{"code":"3003711","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":59.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENZYME CELL ACTIVITY, FPEPA","code_information":[{"code":"3003712","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOG FACS SERUM, MOGFS","code_information":[{"code":"3003713","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86363","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOG FACS TITER, MOGTS","code_information":[{"code":"3003714","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86363","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IG LIGHT CHAINS FREE EA, MSP3","code_information":[{"code":"3003715","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AQAPRN ANTB FLO CYTMTRY EA, NMOTS","code_information":[{"code":"3003716","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VOLTAGE-GTD CA CHNL ANTB EA, PAVAL","code_information":[{"code":"3003717","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANAPLSMA PHGCYTOPHLM AMP PRB, EPCRB","code_information":[{"code":"3003718","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHA CHAFFEENSIS AMP PRB, EPCRB","code_information":[{"code":"3003719","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BORRELIA MIYAMOTOI AMP PRB, TIKLB","code_information":[{"code":"3003720","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87478","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANAPLSMA PHGCYTOPHLM AMP PRB, TIKLB","code_information":[{"code":"3003721","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EHRLICHA CHAFFEENSIS AMP PRB, TIKLB","code_information":[{"code":"3003722","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BABESIA MICROTI AMP PRB, TIKLB","code_information":[{"code":"3003723","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHLAMYDIA AB ADDL, CHLG","code_information":[{"code":"3003724","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":39.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ISLET CELL ANTIBODY, PCDES","code_information":[{"code":"3003725","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INFECT AB SCRN, PCDES","code_information":[{"code":"3003726","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":87.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NON INFECT AB SCRN ADDL, PCDES","code_information":[{"code":"3003727","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":87.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO AQUAPORIN 4 AB, PCDES","code_information":[{"code":"3003728","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MYELIN OLIGO AB, PCDES","code_information":[{"code":"3003729","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86363","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGEN SPECIFIC IGG, FHSPP","code_information":[{"code":"3003730","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HS SO ALLERGEN SPECIFIC IGG ADDL, FHSPP","code_information":[{"code":"3003731","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ANTIEPILEPTICS, BNZU","code_information":[{"code":"3003732","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SEDATIVE HYP, BNZU","code_information":[{"code":"3003733","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":28.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO N-METHYLHISTAMINE 24H, NMH24, NMHR","code_information":[{"code":"3003734","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NATRIURETIC PEPTIDE, PBNP1","code_information":[{"code":"3003735","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MUSK IGG AB TITER REFLEX, FMIGT","code_information":[{"code":"3003736","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.0,"discounted_cash":876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR MODULATING AB REFLEX, FARMO","code_information":[{"code":"3003737","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":394.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MUSK IGG AB CBA REFLEX, FMIGA","code_information":[{"code":"3003738","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":985.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MYASTHENIA GRAVIS REFLEX, FMGRP","code_information":[{"code":"3003739","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":231.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN, FMGRP","code_information":[{"code":"3003740","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WHOLE MITOCHONDRIAL GENOME, MITOP","code_information":[{"code":"3003741","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81465","type":"HCPCS"}],"standard_charges":[{"gross_charge":3075.0,"discounted_cash":1845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PQ TYPE CALCIUM CHANNEL AB CCPQ, MGLE","code_information":[{"code":"3003742","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":27.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MITOTANE (LYSODREN), FMITO","code_information":[{"code":"3003743","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MUCOPOLYSACCHARIDOSIS, MPSBS","code_information":[{"code":"3003744","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CREATININE URINE, NIUCR","code_information":[{"code":"3003745","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AQAPRN4 AB FLOW CYTMTRY, NMOFS","code_information":[{"code":"3003746","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":582.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX NMO AQP4 FACS TITER CSF, NMOTC","code_information":[{"code":"3003747","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SYNTHETIC GLUCOCORTICOID SCREEN, SGSS","code_information":[{"code":"3003748","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":821.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC BD MAX VAG SCREEN","code_information":[{"code":"3003749","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81514","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":427.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TETANUS TOXOID IGG AB, TTIGS","code_information":[{"code":"3003751","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":40.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LYSOSOMAL PEROX STRGE DISORDER, PLSD","code_information":[{"code":"3003752","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":328.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DIPHTHERIA TOXOID IGG AB, DIPGS","code_information":[{"code":"3003753","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CENTROMERE AB IGG, CMA","code_information":[{"code":"3003754","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CELL FUNCTION ASSAY W STIM, DHR","code_information":[{"code":"3003755","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CELL FUNCTION ASSAY W STIM ADDL, DHR","code_information":[{"code":"3003756","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":393.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO VIRUS ANTIBODY NOS, HTLVI","code_information":[{"code":"3003757","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CU INDEX, FCUIX","code_information":[{"code":"3003758","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86343","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBRINOLYSINS SCREEN, CHF8P","code_information":[{"code":"3003759","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":421.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO M PNEUMO MACROLIDE RESIST PCR, RPMPM","code_information":[{"code":"3003760","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":328.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SFMC TRICHOMONAS VAGINALIS PCR","code_information":[{"code":"3003776","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CSF MENINGITIS ENCEPHALITIS PANEL","code_information":[{"code":"3003803","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1935.0,"discounted_cash":1161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LIPOPROTEIN A, LIPA1","code_information":[{"code":"3003804","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COLUMN CHROMOTOGRAPHY, HEX4","code_information":[{"code":"3003805","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CREATININE UR, HEX4","code_information":[{"code":"3003806","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO 5 HYDROXYINDOLEACETIC ACID, HIAAP","code_information":[{"code":"3003807","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DEOXYRIBONUCLEASE AB TITER, ADNAS","code_information":[{"code":"3003808","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEUROFILAMENT LIGHT CHAIN, NFLC","code_information":[{"code":"3003809","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0361U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2916.0,"discounted_cash":1749.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RESPIRATORY SYNCYTIAL VIRUS","code_information":[{"code":"3003810","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":331.0,"discounted_cash":198.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROSTAGLANDIN ASSAY, 23BPT, 23BPR","code_information":[{"code":"3003811","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84150","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PORPHOBILINOGEN ASSAY, PQNRU","code_information":[{"code":"3003812","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PORPHYRINS ASSAY, PQNRU","code_information":[{"code":"3003813","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":47.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LEUKOTRIENE E4 24HR COL CHROMO, TLTE4","code_information":[{"code":"3003814","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VITAMIN B3 AND METABOLITES, VITB3","code_information":[{"code":"3003815","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER, SP5TS","code_information":[{"code":"3003816","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN, SP5CS","code_information":[{"code":"3003817","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":766.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER, K11TS","code_information":[{"code":"3003818","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":369.0,"discounted_cash":221.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER, ITPTS","code_information":[{"code":"3003819","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN, ITPCS","code_information":[{"code":"3003820","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":766.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER, GRFTS","code_information":[{"code":"3003821","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN, GRFCS","code_information":[{"code":"3003822","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":766.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VOLTAGE GTD CA CHANNEL AB EA, MDS2","code_information":[{"code":"3003823","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ISLET CELL AB, MDS2","code_information":[{"code":"3003824","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN, MDS2","code_information":[{"code":"3003825","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN, MDS2","code_information":[{"code":"3003826","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PROTEIN WB, MDS2","code_information":[{"code":"3003827","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO JC VIRUS PCR DETECT AGENT, JCPCR","code_information":[{"code":"3003828","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHERRY IGE, CHER","code_information":[{"code":"3003829","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WHITE FACE HORNET VENOM IGE, WFHV","code_information":[{"code":"3003830","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WHITE PINE IGE, WPIN","code_information":[{"code":"3003831","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACETYLCHOLINESTERASE ASSAY, ACHE","code_information":[{"code":"3003832","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":175.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHICKPEA IGE, CHXP","code_information":[{"code":"3003833","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PINE NUT PIGNOLES IGE, PINE","code_information":[{"code":"3003834","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EPSTEIN-BARR VIRAL CAPSID, SEBV","code_information":[{"code":"3003835","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":23.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EPSTEIN-BARR VIRAL CAPSID, SEBV","code_information":[{"code":"3003836","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":23.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO EPSTEIN-BARR NUCLEAR ANTIGEN, SEBV","code_information":[{"code":"3003837","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UMB CORD 17 TOXI, USDTL","code_information":[{"code":"3003838","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1103.0,"discounted_cash":661.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FATTY ACID PROFILE, FAPEP","code_information":[{"code":"3003843","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BACTERIAL VAGINOSIS INF AGENT DET","code_information":[{"code":"3003844","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":327.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CANDIDA SPP INF AGENT DET","code_information":[{"code":"3003845","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CANDIDA GLABRATA KRUSEI INF AGENT DET","code_information":[{"code":"3003846","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO POMPE DISEASE MASS SPECT REFLEX, PDBS","code_information":[{"code":"3003848","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.0,"discounted_cash":458.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLOBOTRIAOSYLSPHINGOSIN CC REFLEX, LGBBS","code_information":[{"code":"3003849","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":355.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NOROVIRUS PCR, LNORO","code_information":[{"code":"3003850","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NOROVIRUS PCR DET AGENT, LNORO","code_information":[{"code":"3003851","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":97.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC CULTURE TYPING BLOOD PATHOGEN","code_information":[{"code":"3003852","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":1084.0,"discounted_cash":650.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CULTURE TYPING BLOOD PATHOGEN ADDL","code_information":[{"code":"3003854","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":1084.0,"discounted_cash":650.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC HERPES SIMPLEX WHOLE BLD PCR","code_information":[{"code":"3003855","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FREE LIGHT CHAINS K+L IG","code_information":[{"code":"3003856","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FREE LIGHT CHAINS K+L IG","code_information":[{"code":"3003857","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":111.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC VAGINITIS SCREEN MOLECULAR","code_information":[{"code":"3003858","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81514","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":510.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HSV 2 WHOLE BLD PCR","code_information":[{"code":"3003859","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":237.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ENZYME CELL ACTIVITY, HAEV1","code_information":[{"code":"3003861","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF G6PD ENZYME, HAEV1","code_information":[{"code":"3003862","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF GLUTATHIONE, HAEV1","code_information":[{"code":"3003863","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS INIT, HAEV1","code_information":[{"code":"3003864","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS ADDL, HAEV1","code_information":[{"code":"3003865","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":106.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HEMOGLOBIN CHROMOTOGRAPHY, HAEV1","code_information":[{"code":"3003866","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN UNSTABLE SCREEN, HAEV1","code_information":[{"code":"3003867","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83068","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":78.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF NUCLEOTIDASE, HAEV1","code_information":[{"code":"3003868","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY PHOSPHOHEXOSE ENZYMES, HAEV1","code_information":[{"code":"3003869","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84087","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF PYRUVATE KINASE, HAEV1","code_information":[{"code":"3003870","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84220","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":78.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO RBC OSMOTIC FRAGILITY, HAEV1","code_information":[{"code":"3003871","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85557","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLOW CYTOMETRY, HAEV1","code_information":[{"code":"3003872","type":"CDM"},{"code":"0300","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1418.0,"discounted_cash":850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TOXOCARA AB IGG, TOXCG","code_information":[{"code":"3003873","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HYPERSENS AVIAN PANEL INIT, FAVI","code_information":[{"code":"3003874","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HYPERSENS AVIAN PANEL ADDL, FAVI","code_information":[{"code":"3003875","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":1383.0,"discounted_cash":829.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MANNAN BIND LECTIN COMP FUNCTION, MBLF","code_information":[{"code":"3003876","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BUCKWHEAT ALLERGEN IGE EA, BUCW","code_information":[{"code":"3003877","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PSYCHOTROPIC PGX PANEL, PSYQP","code_information":[{"code":"3003878","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81418","type":"HCPCS"}],"standard_charges":[{"gross_charge":4199.0,"discounted_cash":2519.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLOBOTRIAOSYLSPHINGO QUAL QUAN, LGB3S","code_information":[{"code":"3003879","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":355.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UREA 24 HOUR URINE, URAU","code_information":[{"code":"3003880","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTO BLASTO PCR INIT, HBRP","code_information":[{"code":"3003881","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTO BLASTO PCR ADDL, HBRP","code_information":[{"code":"3003882","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PDE10A AB IFA TITER, PDETS, SRPTS","code_information":[{"code":"3003883","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRIM46 AB CBA, T46CS","code_information":[{"code":"3003884","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1813.0,"discounted_cash":1087.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRIM46 AB IFA TITER, T46TS","code_information":[{"code":"3003885","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PDE10A AB IFA TITER CSF, PDETC","code_information":[{"code":"3003886","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRIM46 AB CBA SCREEN CSF, T46CC","code_information":[{"code":"3003887","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1813.0,"discounted_cash":1087.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TRIM46 AB IFA TITER CSF, T46TC","code_information":[{"code":"3003888","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTOPLASMA AB INITIAL, HISER","code_information":[{"code":"3003889","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTOPLASMA AB ADDL, HISER","code_information":[{"code":"3003890","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":28.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO COAG AND FIBRIN FUNCT ACT, ADAMS","code_information":[{"code":"3003891","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":303.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOTTING FACTOR INHIBITOR TEST, ADMB","code_information":[{"code":"3003892","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COAG AND FIBRIN FUNCT ACT, ADAMP","code_information":[{"code":"3003893","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":303.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HISTOPLASMA AND BLASTOMYCES AG, UHBAG","code_information":[{"code":"3003894","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN INIT, MAC1","code_information":[{"code":"3003895","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":67.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN ADDL, MAC1","code_information":[{"code":"3003896","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PROTEIN WB, MAC1","code_information":[{"code":"3003897","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":165.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ISLET CELL AB, MAC1","code_information":[{"code":"3003898","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AQUAPORIN-4 AB FLOW EA, MAC1","code_information":[{"code":"3003899","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN INIT, PCDEC, CRITH","code_information":[{"code":"3003900","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":91.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN ADDL, PCDEC","code_information":[{"code":"3003901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1512.0,"discounted_cash":907.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ISLET CELL AB, PCDEC","code_information":[{"code":"3003902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.0,"discounted_cash":177.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AQUAPORIN-4 AB FLOW EA, PCDEC","code_information":[{"code":"3003903","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":283.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT NONINFECT AGENT AB, APBCC","code_information":[{"code":"3003904","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER, APBTC","code_information":[{"code":"3003905","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGEN SPEC IGE EA, FCATE","code_information":[{"code":"3003906","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGEN SPEC IGE INIT, FHZCP","code_information":[{"code":"3003907","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":148.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGEN SPEC IGE ADDL, FHZCP","code_information":[{"code":"3003908","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.0,"discounted_cash":445.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO OPIOIDS & ANALOGS 5 OR MORE, CSMEU","code_information":[{"code":"3003909","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BENZODIAZEPINES 13 OR MORE, CSMEU","code_information":[{"code":"3003910","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMPHETAMINES 5 OR MORE, CSMEU","code_information":[{"code":"3003911","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DRUG TEST PRSMV CHEM ANLYZR, CSMEU","code_information":[{"code":"3003912","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":205.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALCOHOL BIOMARKERS CONFIRM, ETGC","code_information":[{"code":"3003913","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HLA I TYPING HI RES, HL58R","code_information":[{"code":"3003914","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1451.0,"discounted_cash":870.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHOSPHO TAU 217, PT217","code_information":[{"code":"3003915","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1908.0,"discounted_cash":1144.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UNLISTED CHEMISTRY PROCEDURE, CJDE","code_information":[{"code":"3003916","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS NONAB, CJDE","code_information":[{"code":"3003917","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":795.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS NONAB, CJDE","code_information":[{"code":"3003918","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.0,"discounted_cash":795.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO UNLISTED CHEMISTRY PROCEDURE, RPDE","code_information":[{"code":"3003919","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS NONAB, RPDE","code_information":[{"code":"3003920","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":892.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS NONAB, RPDE","code_information":[{"code":"3003921","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1488.0,"discounted_cash":892.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED","code_information":[{"code":"3003922","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED","code_information":[{"code":"3003923","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC IMMUNOASSAY,OTH QL,SEMQT,MLTISIP","code_information":[{"code":"3003924","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":25.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PENICILLIN G IGE, PBPO","code_information":[{"code":"3003926","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MUSHROOM IGE, MUSH","code_information":[{"code":"3003927","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMOXCILLOYL IGE, AMOXY","code_information":[{"code":"3003928","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CUCUMBER IGE, CUKE","code_information":[{"code":"3003929","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCRN REFLEX, GRFCC","code_information":[{"code":"3003930","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER REFLEX, GRFTC","code_information":[{"code":"3003931","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN REFLEX, ITPCC","code_information":[{"code":"3003932","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER REFLEX, ITPTC","code_information":[{"code":"3003933","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN REFLEX, SP5CC","code_information":[{"code":"3003934","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER REFLEX, SP5TC","code_information":[{"code":"3003935","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB TITER REFLEX, K11TC","code_information":[{"code":"3003936","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCINE ALPHA1 LCBA, GLYCC","code_information":[{"code":"3003937","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0431U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN INIT, MDC2","code_information":[{"code":"3003938","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN ADDL, MDC2","code_information":[{"code":"3003939","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2355.0,"discounted_cash":1413.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PROTEIN WB TEST, MDC2","code_information":[{"code":"3003940","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ISLET CELL AB, MDC2","code_information":[{"code":"3003941","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":110.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ISLET CELL AB, SPPS","code_information":[{"code":"3003942","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":832.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN INIT, SPPS","code_information":[{"code":"3003943","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN ADDL, SPPS","code_information":[{"code":"3003944","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FLUORESCENT AB SCREEN INIT, SPPC","code_information":[{"code":"3003945","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT AB SCREEN ADDL, SPPC","code_information":[{"code":"3003946","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO ISLET CELL AB, SPPC","code_information":[{"code":"3003947","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":832.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WATERMELON IGE, WMEL","code_information":[{"code":"3003948","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CYSTATIN C","code_information":[{"code":"3003949","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":31.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MUSCLE SPECIFIC KINASE AB, MUSK","code_information":[{"code":"3003950","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86366","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTI PHOS AB, PSPTG","code_information":[{"code":"3003951","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":68.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR BINDING AB, ARBI","code_information":[{"code":"3003952","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":120.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEPARIN ASSAY, ARIXTRA","code_information":[{"code":"3003953","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ADENOVIRUS DNA DETECT AND QUANT, ADVQU","code_information":[{"code":"3003956","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":448.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GANGLIOSIDE GQ1B IGG ELISA, GQ1ES","code_information":[{"code":"3003957","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":673.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MYCOPLASMA GENITALIUM AMP PROBE, AMGEN","code_information":[{"code":"3003958","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87563","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.0,"discounted_cash":202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCINE RCPTR ALPHA1 LCBA, GLYCS","code_information":[{"code":"3003959","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0431U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":786.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO THYROID STIM IMMUNOGLOBULIN, FFTSI","code_information":[{"code":"3003962","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO VIT D 1 25-DIHYDROXY, FV125","code_information":[{"code":"3003963","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HBA1/HBA2 GENE DUP/DEL VRNTS, AGDD","code_information":[{"code":"3003964","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.0,"discounted_cash":684.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HHV-6 DNA QUANT, QHV6P","code_information":[{"code":"3003965","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87533","type":"HCPCS"}],"standard_charges":[{"gross_charge":893.0,"discounted_cash":535.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HBB GENE DUP/DEL VARIANTS, WBGDR","code_information":[{"code":"3003966","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81363","type":"HCPCS"}],"standard_charges":[{"gross_charge":2408.0,"discounted_cash":1444.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HBA1/HBA2 GENE DUP/DEL VRNTS, WAGDR","code_information":[{"code":"3003967","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":685.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTI-MULLERIAN HORMONE","code_information":[{"code":"3003972","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82166","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO COL CHROMOTOGRAPHY QUAL/QUAN, GATOL","code_information":[{"code":"3003973","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.0,"discounted_cash":715.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NONAB, VEGF","code_information":[{"code":"3003974","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":96.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN INIT, DYS2","code_information":[{"code":"3003975","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":115.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLUORESCENT ANTIBODY SCREEN ADDL, DYS2","code_information":[{"code":"3003976","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":115.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO RIA NONINFECT, DYS2","code_information":[{"code":"3003977","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGEN SPECIFIC LINSEED IGE, LINS","code_information":[{"code":"3003978","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGEN SPEC CAULIFLOWER IGE, CALFL","code_information":[{"code":"3003979","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLERGEN SPECIFIC LENTIL IGE, LEN","code_information":[{"code":"3003980","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BKV DNA DETECT/QUANT PLASMA","code_information":[{"code":"3003983","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BK VIRUS DNA DETECT/QUANT URINE","code_information":[{"code":"3003984","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EBV DNA DETECT/QUANT PLASMA","code_information":[{"code":"3003985","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HBV DNA DETECT/QUANT SERUM","code_information":[{"code":"3003986","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MICROBIOLOGY UNLISTED PROC, JOINT INFECTION PANEL","code_information":[{"code":"3003987","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2876.0,"discounted_cash":1725.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MYCOBACTERIA TUBERCULOSIS, DNA/RNA RIFAMPIN RESISTANCE AMPLIFIED PROBE","code_information":[{"code":"3003988","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87564","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALKALINE PHOSPHATASE, ALKP","code_information":[{"code":"3003989","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALKALINE PHOSPHATASE ISOENZYMES, ALKP","code_information":[{"code":"3003990","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOMEG PCR LOWER RESP, CMVLR","code_information":[{"code":"3003991","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO STREP PNEUM ANTIBODY IGG SEROTYPES, PN23M","code_information":[{"code":"3003992","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86581","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURO-ONC EXPANDED PANEL, NONCP","code_information":[{"code":"3003994","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81457","type":"HCPCS"}],"standard_charges":[{"gross_charge":13923.0,"discounted_cash":8353.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHOSPHO-TAU(217), PT217","code_information":[{"code":"3003995","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1071.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PNEUMOCYSTIS PCR, PNRP","code_information":[{"code":"3003996","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87594","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LYNCH SYNDROME PANEL, LYNCP","code_information":[{"code":"3003997","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81435","type":"HCPCS"}],"standard_charges":[{"gross_charge":6248.0,"discounted_cash":3748.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALZHEIMERS DISEASE EVAL ABETA 42, ADEVL","code_information":[{"code":"3003998","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82234","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALZHEIMERS DISEASE EVAL TAU EACH, ADEVL","code_information":[{"code":"3003999","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALZHEIMERS DISEASE EVAL TOTAL TAU, ADEVL","code_information":[{"code":"3004000","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84394","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEPTOR BINDING AB, MGMR","code_information":[{"code":"3004002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":112.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ACHR MOD FLOW CYTO, ACMFS","code_information":[{"code":"3004003","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACH RECEP MUSCLE BINDING AB, MGLE","code_information":[{"code":"3004004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.0,"discounted_cash":402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ","code_information":[{"code":"3004005","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS NONAB, GALOP AB","code_information":[{"code":"3004006","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2071.0,"discounted_cash":1242.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HPV SEP RPRT HI-RSK TYP & HI-RSK POOLD RSLTS","code_information":[{"code":"3004007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"G0476","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMITRIPTYLINE AND NORTRIPTYLINE, AMTRP","code_information":[{"code":"3004008","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":47.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLOMIPRAMINE, CLOM","code_information":[{"code":"3004009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LIDOCAINE, LID","code_information":[{"code":"3004011","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":103.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY QUANT NOS NONAB, SIL2R","code_information":[{"code":"3004012","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":278.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY NEURFLMNT LIGHT CHAIN, NFLP","code_information":[{"code":"3004013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83884","type":"HCPCS"}],"standard_charges":[{"gross_charge":3069.0,"discounted_cash":1841.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEPATITIS C REVRS TRNSCRPJ, HCVQN","code_information":[{"code":"3004014","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":214.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALLG SPEC IGE CRUDE XTRC EA, TILAP","code_information":[{"code":"3004015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INSULIN ANTIBODIES, DBS1, FDAIP","code_information":[{"code":"3004018","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ISLET CELL ANTIBODY INTL, DBS1, FDAIP","code_information":[{"code":"3004019","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ISLET CELL ANTIBODY ADDL, DBS1, FDAIP","code_information":[{"code":"3004020","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO TREPONEMA PALLIDUM, NSAIP","code_information":[{"code":"3004028","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY OF SERUM ALBUMIN, NSAI","code_information":[{"code":"3004029","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO OTHER SOURCE ALBUMIN QUAN EA, NSAI","code_information":[{"code":"3004030","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY IGA/IGD/IGG/IGM INTL, NSAI","code_information":[{"code":"3004031","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ASSAY IGA/IGD/IGG/IGM, ADDL, NSAI","code_information":[{"code":"3004032","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO TREPONEMA PALLIDUM, INTL, NSAI","code_information":[{"code":"3004033","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TREPONEMA PALLIDUM, ADDL, NSAI","code_information":[{"code":"3004034","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC CULTURE TYPING ID BY AMP PROBE, INTL","code_information":[{"code":"3004039","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":167.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CULTURE TYPING ID BY AMP PROBE, ADDL","code_information":[{"code":"3004040","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":100.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC CAP BLOOD GASES: PH, PO2, & PC02","code_information":[{"code":"3004059","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO F TULARENSIS AB IGM/IGG INIT, TULAB","code_information":[{"code":"3004085","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO F TULARENSIS AB IGM/IGG ADDL, TULAB","code_information":[{"code":"3004086","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":102.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO RO52 AND RO60 ANTIBODIES IGG INIT, ROPAN","code_information":[{"code":"3004087","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":462.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO RO52 AND RO60 ANTIBODIES IGG ADDL, ROPAN","code_information":[{"code":"3004088","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":462.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO PHENOTYPE INFECT AGENT, ARUP ZW242","code_information":[{"code":"3004089","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":342.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NFCT AGT GNTYP ALYS HIV1 REV, ARUP ZW242","code_information":[{"code":"3004090","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":342.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NFCT AGT GNTYP ALYS HIV1 OTHER REG, ARUP ZW242","code_information":[{"code":"3004091","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.0,"discounted_cash":342.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV-1 PROBE & REVERSE TRNSCRIPJ, HIP12","code_information":[{"code":"3004095","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HIV-2 PROBE & REVERSE TRNSCRIPJ, HIP12","code_information":[{"code":"3004096","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87538","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ANTINUCLEAR ANTIBODIES, FSCPR","code_information":[{"code":"3004097","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOASSAY NONAB, FSCPR","code_information":[{"code":"3004098","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NUCLEAR ANTIGEN AB INIT, FSCPR","code_information":[{"code":"3004099","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":95.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NUCLEAR ANTIGEN AB ADDL, FSCPR","code_information":[{"code":"3004100","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":95.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FLUORESCENT ANTIBODY TITER, FSCPR","code_information":[{"code":"3004101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REPEAT ANTI SCL-70 REFLEX, FCA70","code_information":[{"code":"3004102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO H PYLORI CULTURE SCRN AND SUSC, HELIS","code_information":[{"code":"3004103","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AMYLASE PANCREATIC CYST, AMLPC","code_information":[{"code":"3004104","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHENOTYPE INFECT AGENT DRUG, HCVDR","code_information":[{"code":"3004105","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":396.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INFCT AGT GNTYP ALYS HEP C, HCVDR","code_information":[{"code":"3004106","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":1303.0,"discounted_cash":781.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HDV RNA DETECT/QUANT, HDVQU","code_information":[{"code":"3004108","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87523","type":"HCPCS"}],"standard_charges":[{"gross_charge":2499.0,"discounted_cash":1499.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLUCOSE BF, OTHER THAN BLOOD, GLBF","code_information":[{"code":"3004109","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GRANULOCYTE AB SCRN INIT, LAGGN","code_information":[{"code":"3004111","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GRANULOCYTE AB SCRN ADDL, LAGGN","code_information":[{"code":"3004112","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NUCLEOTIDASE 5'-, 5NTD","code_information":[{"code":"3004113","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TAU PHOSPHORYLATED EACH, RPDE","code_information":[{"code":"3004114","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TOTAL TAU, RPDE","code_information":[{"code":"3004115","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84394","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BETA-AMYLOID 1-42, RPDE","code_information":[{"code":"3004116","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82234","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":333.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL, RPDE","code_information":[{"code":"3004119","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0584U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2330.0,"discounted_cash":1398.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO METHYLMALONIC ACID SINGLE QN, MMAP","code_information":[{"code":"3004120","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INF AGENT DETECTION BY NUCLEIC ACID, JIP","code_information":[{"code":"3004121","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87627","type":"HCPCS"}],"standard_charges":[{"gross_charge":2862.0,"discounted_cash":1717.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INF AGENT DETECTION BY NUCLEIC ACID, CGRNA, MCTGC","code_information":[{"code":"3004122","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87494","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ENHANCED LIVER FIBROSIS TEST, ELF","code_information":[{"code":"3004124","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81517","type":"HCPCS"}],"standard_charges":[{"gross_charge":1020.0,"discounted_cash":612.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CFTR GENE FULL SEQUENCE, PANGP","code_information":[{"code":"3004125","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":2568.0,"discounted_cash":1540.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 5 INIT, PANGP","code_information":[{"code":"3004126","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1415.0,"discounted_cash":849.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 5 ADDL, PANGP","code_information":[{"code":"3004127","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1415.0,"discounted_cash":849.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 6 INIT, PANGP","code_information":[{"code":"3004128","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":930.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 6 ADDL, PANGP","code_information":[{"code":"3004129","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":930.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO SOLUBLE TRANSFERRIN RECEPTOR, STFR1","code_information":[{"code":"3004130","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84238","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURO ONC EXPANDED PANEL 51/>RNA ANAL, NONCP","code_information":[{"code":"3004131","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81456","type":"HCPCS"}],"standard_charges":[{"gross_charge":5988.0,"discounted_cash":3592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, HBEL1","code_information":[{"code":"3004133","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":24.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL, CJDE","code_information":[{"code":"3004134","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0584U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1612.0,"discounted_cash":967.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TOTAL TAU, CJDE","code_information":[{"code":"3004135","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84394","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TAU PHOSPHORYLATED EACH, CJDE","code_information":[{"code":"3004136","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84393","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC URINALYSIS,NON AUTO W/O MICROSCOPY","code_information":[{"code":"3090002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":68.0,"discounted_cash":40.8,"setting":"outpatient","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"HC CA SCREEN, OCCULT BLOOD, 1-3 DETERM","code_information":[{"code":"3090003","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":40.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CAPILL BLOOD GLUCOSE/ MONITOR BY DEVICE","code_information":[{"code":"3090004","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AMNISURE ROM TEST","code_information":[{"code":"3090005","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":259.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HEPATITIS C RNA","code_information":[{"code":"3090007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":391.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":595.0,"discounted_cash":357.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INFECT AGNT DETEC OBSERV RSV","code_information":[{"code":"3090008","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87807","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":96.6,"setting":"both","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"HC HEPARIN ASSAY","code_information":[{"code":"3090013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COAGULATION TIME, ACTIVATED","code_information":[{"code":"3090014","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC STREP GROUP A ANTIGEN POC","code_information":[{"code":"3090015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":123.0,"discounted_cash":73.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC URINE PREGNANCY TEST, QUAL POC","code_information":[{"code":"3090016","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC OCCULT  BLOOD, FECES,1 SPEC POC","code_information":[{"code":"3090017","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":40.0,"discounted_cash":24.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ROM PLUS PP12 & AFP","code_information":[{"code":"3090018","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":259.0,"discounted_cash":155.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SKIN TEST - TUBERCULOSIS, INTRADERMAL","code_information":[{"code":"3090019","type":"CDM"},{"code":"0309","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":46.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PROTHROMBIN TIME-FINGER STICK","code_information":[{"code":"3090020","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"3090022","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COAGULATION TIME, OTHER METHODS","code_information":[{"code":"3090030","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85348","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.0,"discounted_cash":92.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":141.0,"discounted_cash":84.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC POCT INFLUENZA A & B","code_information":[{"code":"3090031","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC POCT MONO","code_information":[{"code":"3090032","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":99.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC POCT URINALYSIS MACROSCOPIC ONLY AUTO","code_information":[{"code":"3090035","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC POCT HEMOGLOBIN GLYCOSYLATED HBA1C","code_information":[{"code":"3090038","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BONE MARROW, SMEAR INTERPRETATION","code_information":[{"code":"3100002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CYTO SMEAR, NON-GYN","code_information":[{"code":"3100003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":337.0,"discounted_cash":202.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTO SMEAR, CONCENTRATION TECHIQUE","code_information":[{"code":"3100004","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":231.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTOPATHOLOGY, CELL ENHANCEMENT TECH","code_information":[{"code":"3100005","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":383.0,"discounted_cash":229.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTO SMEAR, OTHER","code_information":[{"code":"3100008","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88160","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":337.0,"discounted_cash":202.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTO SMEAR, MISC, PREP & SCREEN","code_information":[{"code":"3100009","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88161","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":303.0,"discounted_cash":181.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTOPATHOLOGY, BETHESDA, MANUAL","code_information":[{"code":"3100010","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":151.0,"discounted_cash":90.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FNA, IMMED EVAL OF SPEC, ADEQUACY ONLY","code_information":[{"code":"3100011","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":265.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTOPATHOLOGY, FNA EVALUATION","code_information":[{"code":"3100012","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":505.0,"discounted_cash":303.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTO,THIN LAYER PREP;AUTO SCN MAN RESCN","code_information":[{"code":"3100013","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":311.0,"discounted_cash":186.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC LAB FLOW CYTO; CELL CYCLE/DNA ANALYSIS","code_information":[{"code":"3100014","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88182","type":"HCPCS"}],"standard_charges":[{"gross_charge":921.0,"discounted_cash":552.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":867.0,"discounted_cash":520.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC LAB FLOW CYTOMETRY ADDTL MARKER,EA","code_information":[{"code":"3100015","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CULTURE FOR CHROMOS ANALYSIS","code_information":[{"code":"3100016","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":936.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1470.0,"discounted_cash":882.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TISSUE CULT,SKIN/SOLID TISS BX","code_information":[{"code":"3100017","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":1859.0,"discounted_cash":1115.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1751.0,"discounted_cash":1050.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TISSUE CULTURE,AMNIOTIC FLUID OR CV","code_information":[{"code":"3100018","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1759.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2766.0,"discounted_cash":1659.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC TISS CULTURE BM/BLD CELLS LAB TEST","code_information":[{"code":"3100019","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1655.0,"discounted_cash":993.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1561.0,"discounted_cash":936.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALY, 15-20 CELLS/2 KARYO W/BAND","code_information":[{"code":"3100022","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":2612.0,"discounted_cash":1567.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2048.0,"discounted_cash":1228.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALYS, 45 CELLS, MOSAIC, 2 KARYO","code_information":[{"code":"3100023","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88263","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.0,"discounted_cash":852.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1338.0,"discounted_cash":802.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALYSIS; ANALYZE 20-25 CELLS","code_information":[{"code":"3100024","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2234.0,"discounted_cash":1340.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2104.0,"discounted_cash":1262.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROM ANALY,AMNIO,6-12 COL/1 KARY","code_information":[{"code":"3100025","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88269","type":"HCPCS"}],"standard_charges":[{"gross_charge":1864.0,"discounted_cash":1118.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1756.0,"discounted_cash":1053.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100026","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":570.0,"discounted_cash":342.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMOSOMAL IN SITU HYBRIDIZATION, ANALY","code_information":[{"code":"3100027","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88273","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":568.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":894.0,"discounted_cash":536.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTO-GENTIC,IN SITU HYBRD,25-99 CELL","code_information":[{"code":"3100028","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1418.0,"discounted_cash":850.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100029","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":523.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":821.0,"discounted_cash":492.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALY, ADDNL KARYOTYPE, EA","code_information":[{"code":"3100030","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":345.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":543.0,"discounted_cash":325.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALY,ADD'L KARYO AND CELLS","code_information":[{"code":"3100031","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88285","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":582.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":760.0,"discounted_cash":456.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROM ANALY, HIGH RESOLU PROPHASE","code_information":[{"code":"3100032","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88289","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":655.0,"discounted_cash":393.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTOGEN/MOLECULAR CYTOGEN, INTERP/REPORT","code_information":[{"code":"3100033","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":180.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED CYTOGENETIC STUDY","code_information":[{"code":"3100034","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88299","type":"HCPCS"}],"standard_charges":[{"gross_charge":3818.0,"discounted_cash":2290.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3599.0,"discounted_cash":2159.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SURG PATH LEVEL I, GROSS ONLY","code_information":[{"code":"3100035","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LEVEL II SURG PATH GROSS & MICRO","code_information":[{"code":"3100036","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":313.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":493.0,"discounted_cash":295.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LEVEL III SURG PATH GROSS & MICRO ONLY","code_information":[{"code":"3100037","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":630.0,"discounted_cash":378.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LEVEL IV SURG PATH GROSS & MICRO","code_information":[{"code":"3100038","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.0,"discounted_cash":491.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":771.0,"discounted_cash":462.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LEVEL V SURG PATH GROSS & MICRO ONLY","code_information":[{"code":"3100039","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.0,"discounted_cash":526.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":828.0,"discounted_cash":496.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC LEVEL VI SURG PATH GROSS & MICRO ONLY","code_information":[{"code":"3100040","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1908.0,"discounted_cash":1144.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1898.0,"discounted_cash":1138.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DECALCIFICATION PROC","code_information":[{"code":"3100041","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SPECIAL STAINS, GRP 1","code_information":[{"code":"3100042","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":320.0,"discounted_cash":192.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SPECIAL STAIN GRP 2","code_information":[{"code":"3100043","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC GROUP II, HISTOCHEM STAIN W/FROZEN SECT","code_information":[{"code":"3100044","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":437.0,"discounted_cash":262.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC HISTOCHEM TO DETERM ENZ CONST, EA","code_information":[{"code":"3100045","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CONSULT & RPT ON REF MATER W SLIDES","code_information":[{"code":"3100047","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":999.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1568.0,"discounted_cash":940.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CONSULT/RPT, REFER MATL, PATH PT COMPREH","code_information":[{"code":"3100048","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":1840.0,"discounted_cash":1104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1734.0,"discounted_cash":1040.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PATH CONSULTATION DURING SURGERY","code_information":[{"code":"3100049","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FROZEN SECTION","code_information":[{"code":"3100050","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":655.0,"discounted_cash":393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":617.0,"discounted_cash":370.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ADDITIONAL FROZEN SECTIONS","code_information":[{"code":"3100051","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":679.0,"discounted_cash":407.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PATH CONSULT IN SURG; CYTOL EXAM, INIT","code_information":[{"code":"3100052","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PATH CONSULT IN SURG; CYTOL EXAM, ADDL","code_information":[{"code":"3100053","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":155.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":200.0,"discounted_cash":120.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DIRECT IMMUNOFLUOR (TISSUE)","code_information":[{"code":"3100055","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":635.0,"discounted_cash":381.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ELECTRON MICROSCOPY; DX","code_information":[{"code":"3100057","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":4054.0,"discounted_cash":2432.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3819.0,"discounted_cash":2291.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MORPHOMETRIC ANALY HISTOCHEM","code_information":[{"code":"3100058","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":389.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":579.0,"discounted_cash":347.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MORPHOMETRIC ANALY,HISTO COMP ASSIST","code_information":[{"code":"3100059","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":523.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":705.0,"discounted_cash":423.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IN SITU HYBRIDIZATION,EACH PROBE","code_information":[{"code":"3100060","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.0,"discounted_cash":509.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":801.0,"discounted_cash":480.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MORPHOMETRIC ANL EA PRB COMP ASSIST","code_information":[{"code":"3100061","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":874.0,"discounted_cash":524.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC THIN PREP PAP,SCREENING","code_information":[{"code":"3100063","type":"CDM"},{"code":"0311","type":"RC"},{"code":"G0143","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PAP SMEAR,SCREENING","code_information":[{"code":"3100064","type":"CDM"},{"code":"0311","type":"RC"},{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTO (FISH) URINARY TRACT 3-5 PROBES MANL","code_information":[{"code":"3100065","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1557.0,"discounted_cash":934.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1223.0,"discounted_cash":733.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CYTO EVAL OF FNA, IMMEDIATE EA EPISODE","code_information":[{"code":"3100067","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC ARCHIVAL TISSUE MOLECULAR EXAM","code_information":[{"code":"3100068","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88363","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MICRODISSECTION, MANUAL","code_information":[{"code":"3100070","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":1176.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1849.0,"discounted_cash":1109.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  FLOW CYTOMETRY ADDNL MARKER,EA","code_information":[{"code":"3100072","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100073","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":599.0,"discounted_cash":359.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100074","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100075","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":361.0,"discounted_cash":216.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC  INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100076","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC BONE MARROW, SMEAR INTERPRETATION","code_information":[{"code":"3100078","type":"CDM"},{"code":"0310","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TISSUE CULT,SKIN/SOLID TISS BX","code_information":[{"code":"3100079","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":2530.0,"discounted_cash":1518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2386.0,"discounted_cash":1431.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TISSUE CULTURE,AMNIOTIC FLUID OR CV","code_information":[{"code":"3100080","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1759.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2766.0,"discounted_cash":1659.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TISS CULTURE, NEO, BONE MARROW/BLD CELLS","code_information":[{"code":"3100081","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1655.0,"discounted_cash":993.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1561.0,"discounted_cash":936.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC TISS CULTURE, NEO, BONE MARROW/BLD CELLS","code_information":[{"code":"3100082","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1655.0,"discounted_cash":993.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1561.0,"discounted_cash":936.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALYSIS; ANALYZE 20-25 CELLS","code_information":[{"code":"3100083","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2176.0,"discounted_cash":1305.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2048.0,"discounted_cash":1228.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALYSIS; ANALYZE 20-25 CELLS","code_information":[{"code":"3100084","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1761.0,"discounted_cash":1056.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1659.0,"discounted_cash":995.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALY, ADDNL KARYOTYPE, EA","code_information":[{"code":"3100085","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":345.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":543.0,"discounted_cash":325.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED CYTOGENETIC STUDY","code_information":[{"code":"3100086","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88299","type":"HCPCS"}],"standard_charges":[{"gross_charge":2314.0,"discounted_cash":1388.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":2178.0,"discounted_cash":1306.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC UNLISTED CYTOGENETIC STUDY","code_information":[{"code":"3100087","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88299","type":"HCPCS"}],"standard_charges":[{"gross_charge":3818.0,"discounted_cash":2290.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3599.0,"discounted_cash":2159.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLOW CYTOMETRY ADDNL MARKER,EA","code_information":[{"code":"3100092","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100093","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":456.0,"discounted_cash":273.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100095","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":637.0,"discounted_cash":382.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC BONE MARROW, SMEAR INTERPRETATION","code_information":[{"code":"3100100","type":"CDM"},{"code":"0310","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC CYTO SMEAR, NON-GYN","code_information":[{"code":"3100101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":337.0,"discounted_cash":202.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC FLOW CYTOMETRY ADDNL MARKER,EA","code_information":[{"code":"3100102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC CHROMO ANALYSIS; ANALYZE 20-25 CELLS","code_information":[{"code":"3100103","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2234.0,"discounted_cash":1340.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":2104.0,"discounted_cash":1262.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100104","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":599.0,"discounted_cash":359.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100105","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":523.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":821.0,"discounted_cash":492.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC CHROMO ANALY, ADDNL KARYOTYPE, EA","code_information":[{"code":"3100106","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":345.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":543.0,"discounted_cash":325.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SURG PATH LEVEL I, GROSS ONLY","code_information":[{"code":"3100107","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC LEVEL II SURG PATH GROSS & MICRO","code_information":[{"code":"3100108","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":313.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":493.0,"discounted_cash":295.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC LEVEL III SURG PATH GROSS & MICRO ONLY","code_information":[{"code":"3100109","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":630.0,"discounted_cash":378.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC LEVEL IV SURG PATH GROSS & MICRO","code_information":[{"code":"3100110","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.0,"discounted_cash":491.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":771.0,"discounted_cash":462.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC LEVEL V SURG PATH GROSS & MICRO ONLY","code_information":[{"code":"3100111","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.0,"discounted_cash":605.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":952.0,"discounted_cash":571.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC LEVEL VI SURG PATH GROSS & MICRO ONLY","code_information":[{"code":"3100112","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":2195.0,"discounted_cash":1317.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":2182.0,"discounted_cash":1309.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC DECALCIFICATION PROC","code_information":[{"code":"3100113","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SPECIAL STAINS, GRP 1","code_information":[{"code":"3100114","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":320.0,"discounted_cash":192.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SPECIAL STAIN GRP 2","code_information":[{"code":"3100115","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":405.0,"discounted_cash":243.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":320.0,"discounted_cash":192.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC GROUP II, HISTOCHEM STAIN W/FROZEN SECT","code_information":[{"code":"3100116","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":437.0,"discounted_cash":262.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC HISTOCHEM TO DETERM ENZ CONST, EA","code_information":[{"code":"3100117","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC ADDITIONAL FROZEN SECTIONS","code_information":[{"code":"3100118","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":432.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":679.0,"discounted_cash":407.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC DIRECT IMMUNOFLUOR (TISSUE)","code_information":[{"code":"3100120","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":635.0,"discounted_cash":381.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DIRECT IMMUNOFLUOR (TISSUE)","code_information":[{"code":"3100121","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":635.0,"discounted_cash":381.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MORPHOMETRIC ANALY,HISTO COMP ASSIST","code_information":[{"code":"3100122","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":523.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":705.0,"discounted_cash":423.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC IN SITU HYBRIDIZATION,EACH PROBE","code_information":[{"code":"3100123","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":560.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":882.0,"discounted_cash":529.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MORPHOMETRIC ANL EA PRB COMP ASSIST","code_information":[{"code":"3100124","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":874.0,"discounted_cash":524.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MORPHOMETRIC ANL EA PRB COMP ASSIST","code_information":[{"code":"3100125","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":874.0,"discounted_cash":524.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MORPHOMETRIC ANL EA PRB COMP ASSIST","code_information":[{"code":"3100126","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":874.0,"discounted_cash":524.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC FUNG SILVER STAIN LAB TEST","code_information":[{"code":"3100129","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":286.0,"discounted_cash":171.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CHROMO ANALY, ADDNL KARYOTYPE, EA","code_information":[{"code":"3100130","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":345.6,"setting":"both","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":543.0,"discounted_cash":325.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100132","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":839.0,"discounted_cash":503.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC FLOW CYTOMETRY ADDNL MARKER,EA","code_information":[{"code":"3100133","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100134","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":599.0,"discounted_cash":359.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100135","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100136","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":599.0,"discounted_cash":359.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100137","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100138","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":599.0,"discounted_cash":359.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100139","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100140","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":839.0,"discounted_cash":503.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC FLOW CYTOMETRY ADDNL MARKER,EA","code_information":[{"code":"3100141","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MOLECULAR CYTOGENETICS; DNA PROBE, EACH","code_information":[{"code":"3100142","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.0,"discounted_cash":381.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":599.0,"discounted_cash":359.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100143","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":839.0,"discounted_cash":503.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC FLOW CYTOMETRY ADDNL MARKER,EA","code_information":[{"code":"3100144","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":273.0,"discounted_cash":163.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC INTERPHASE IN SITU HYBRIDIZATION,ANALYSI","code_information":[{"code":"3100145","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":839.0,"discounted_cash":503.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETIC INTERPRETATION (FAML)","code_information":[{"code":"3100156","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":319.0,"discounted_cash":191.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOHISTOCHEMISTRY PER SPECIMEN; INITIAL SINGLE ANTIBODY","code_information":[{"code":"3100159","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":542.0,"discounted_cash":325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":538.0,"discounted_cash":322.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOHISTOCHEMISTRY, PER SPECIMEN; EACH ADDITIONAL SINGLE ANTIBODY","code_information":[{"code":"3100160","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":374.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":587.0,"discounted_cash":352.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SFMC HER-2 FISH LAB TEST","code_information":[{"code":"3100166","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":843.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURG PATH PROSTATE BIOSPY, ANY METHOD","code_information":[{"code":"3100167","type":"CDM"},{"code":"0310","type":"RC"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":7346.0,"discounted_cash":4407.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":6922.0,"discounted_cash":4153.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC IMMUNOHISTOCHEM PER SPECIMEN; EA MULTIPLEX ANTIBODY","code_information":[{"code":"3100168","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":538.0,"discounted_cash":322.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EA","code_information":[{"code":"3100169","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":260.0,"discounted_cash":156.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR CYTOGENETICS DNA PROBE EA","code_information":[{"code":"3100170","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":260.0,"discounted_cash":156.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC MOLECULAR INTERPHASE ISH ANALYZE 100-300 CLL","code_information":[{"code":"3100171","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":307.0,"discounted_cash":184.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MOLECULAR INTERPHASE ISH ANALYZE 100-300 CLL","code_information":[{"code":"3100172","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.0,"discounted_cash":190.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":307.0,"discounted_cash":184.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO BWS/RSS MOLECULAR ANALY, BWRS","code_information":[{"code":"3100173","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":723.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1169.0,"discounted_cash":701.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO BWS/RSS MOLECULAR ANALY, BWRS","code_information":[{"code":"3100174","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":723.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":1169.0,"discounted_cash":701.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTO INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL FUROC","code_information":[{"code":"3100175","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":974.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":1576.0,"discounted_cash":945.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC SO PLINK FLOW/TC 1 MARKER, PNH","code_information":[{"code":"3100176","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PLINK FLOW/TC ADD-ON EA ADDTL, PNH","code_information":[{"code":"3100177","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.0,"discounted_cash":226.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC FLOW CYTO CELL SURF MARKER TCHNCL ONLY EA","code_information":[{"code":"3100178","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FLOW CYTO CELL SURF MARKER TCHNCL ONLY EA","code_information":[{"code":"3100179","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SFMC MULTIPLEX HER-2 FISH LAB TEST","code_information":[{"code":"3100183","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88366","type":"HCPCS"}],"standard_charges":[{"gross_charge":1466.0,"discounted_cash":879.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TISSUE CULTURE SKIN/BIOPSY, CHRPC","code_information":[{"code":"3100184","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":2077.0,"discounted_cash":1246.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, POCRF","code_information":[{"code":"3100185","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"discounted_cash":1140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, POCRF","code_information":[{"code":"3100186","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1900.0,"discounted_cash":1140.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO TISSUE CULTURE TUMOR, CHRLN","code_information":[{"code":"3100187","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":3853.0,"discounted_cash":2311.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, CLLF","code_information":[{"code":"3100188","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, CLLF","code_information":[{"code":"3100189","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":291.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, MDSF","code_information":[{"code":"3100190","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, MDSF","code_information":[{"code":"3100191","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, BLPF","code_information":[{"code":"3100192","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, BLPF","code_information":[{"code":"3100193","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, PCPDF","code_information":[{"code":"3100194","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":587.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, PCPDF","code_information":[{"code":"3100195","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":587.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, GLIOF","code_information":[{"code":"3100196","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2210.0,"discounted_cash":1326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, GLIOF","code_information":[{"code":"3100197","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2210.0,"discounted_cash":1326.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, PADF","code_information":[{"code":"3100198","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":368.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, PADF","code_information":[{"code":"3100199","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":368.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, BALLF","code_information":[{"code":"3100200","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":317.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL, BALLF","code_information":[{"code":"3100201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.0,"discounted_cash":317.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, AMLF","code_information":[{"code":"3100202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADDTL,AMLF","code_information":[{"code":"3100203","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":291.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO IMMUNOFLUOR ANTB 1ST STAIN,PROM IBD PANCA","code_information":[{"code":"3100204","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":209.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOFLUOR ANTB ADDTL STAIN,PROM IBD DNASE","code_information":[{"code":"3100205","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMMUNOFLUOR ANTB ADDTL STAIN","code_information":[{"code":"3100206","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":463.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOFLUOR ANTB ADDTL STAIN, FAEAB","code_information":[{"code":"3100207","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":468.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO TISSUE CULTURE TUMOR CHRST","code_information":[{"code":"3100220","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88239","type":"HCPCS"}],"standard_charges":[{"gross_charge":6586.0,"discounted_cash":3951.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IMMUNOFLUOR ANTB PER SPEC 1ST STAIN","code_information":[{"code":"3100221","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":339.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PLASMA CELL MARKER MSMART","code_information":[{"code":"3100222","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1509.0,"discounted_cash":905.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLOWCYTOMETRY 1ST TC MSMART","code_information":[{"code":"3100223","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1250.0,"discounted_cash":750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENTICS DNA 1ST PROBE MPCPD FISH","code_information":[{"code":"3100224","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":587.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENTICS DNA 2ND PROBE MPCPD FISH","code_information":[{"code":"3100225","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":587.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOPATH LEVEL 2 APOEG","code_information":[{"code":"3100226","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2056.0,"discounted_cash":1233.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, 922F","code_information":[{"code":"3100227","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADDL, 922F","code_information":[{"code":"3100228","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MTHFR GENE, MTHP","code_information":[{"code":"3100235","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1041.0,"discounted_cash":624.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROMOSOMAL MICROARRAY, CMAP, CMAMT","code_information":[{"code":"3100236","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":7049.0,"discounted_cash":4229.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CHROMOSOMAL MICROARRAY, CMAPC","code_information":[{"code":"3100237","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":7049.0,"discounted_cash":4229.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRCA1/BRCA2 GENES, FULL ANALYS, BRCAZ","code_information":[{"code":"3100238","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":8437.0,"discounted_cash":5062.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 7, RETZ","code_information":[{"code":"3100239","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":5646.0,"discounted_cash":3387.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 6, P53CA","code_information":[{"code":"3100240","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1763.0,"discounted_cash":1057.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLOWCYTOMETRY TC 1ST MARKER, CKP53","code_information":[{"code":"3100241","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.0,"discounted_cash":1010.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYP2C19 GENE ANALYSIS COMMON VARIANTS,  2C19B","code_information":[{"code":"3100242","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1692.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PTEN GENE ANALYSIS FULL SEQUENCE,  PTENZ","code_information":[{"code":"3100243","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81321","type":"HCPCS"}],"standard_charges":[{"gross_charge":4227.0,"discounted_cash":2536.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYP2D6 GENE COMMON VARIANTS, 2D6CB","code_information":[{"code":"3100244","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.0,"discounted_cash":1042.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MTHFR GENE ANALYSIS COMMON VARIANTS, MTHAC","code_information":[{"code":"3100245","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MITOCHONDRIAL FULL GENOME ANALYSIS, MITOP","code_information":[{"code":"3100246","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81460","type":"HCPCS"}],"standard_charges":[{"gross_charge":9397.0,"discounted_cash":5638.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 2, GAL14","code_information":[{"code":"3100247","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1692.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TARGETED GEN SEQ ANALYSIS, SOLID ORGAN , MELP","code_information":[{"code":"3100248","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81445","type":"HCPCS"}],"standard_charges":[{"gross_charge":5168.0,"discounted_cash":3100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO AORTIC DYSFUNCTION OR DILATION, MFRGP","code_information":[{"code":"3100249","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81410","type":"HCPCS"}],"standard_charges":[{"gross_charge":11630.0,"discounted_cash":6978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 4, MPLB","code_information":[{"code":"3100250","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 7, MPS1Z","code_information":[{"code":"3100251","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":5168.0,"discounted_cash":3100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TARGETED GEN SEQ ANALYSIS, HEMATOLYMPHOID, NGSAM","code_information":[{"code":"3100252","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":7049.0,"discounted_cash":4229.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TARGETED GEN SEQ ANALYSIS, HEMATOLYMPHOID, NGSHM","code_information":[{"code":"3100253","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":8459.0,"discounted_cash":5075.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 1, IL28V","code_information":[{"code":"3100254","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 2,  TPMT, TPNUV","code_information":[{"code":"3100255","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.0,"discounted_cash":550.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UNLISTED MOLECULAR,  NUDT5, TPNUV","code_information":[{"code":"3100256","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.0,"discounted_cash":550.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRCA1-BRCA2, BRST6","code_information":[{"code":"3100271","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":5304.0,"discounted_cash":3182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CDH1, BRST6","code_information":[{"code":"3100272","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":400.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PTEN, BRST6","code_information":[{"code":"3100273","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRST CANCR GENE PANEL 6, BRST6","code_information":[{"code":"3100274","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRST CANCR GENE PANEL 6, BRST6 ADDL","code_information":[{"code":"3100275","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LUNG CNCR ALK REARG FISH, LCAF","code_information":[{"code":"3100276","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.0,"discounted_cash":690.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO LUNG CNCR ALK RERG FISH, ADDL LCAF","code_information":[{"code":"3100277","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1151.0,"discounted_cash":690.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROINSULIN INTACT, FPINS","code_information":[{"code":"3100298","type":"CDM"},{"code":"0310","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLC25A20 GENE ANALYSIS, CACTZ","code_information":[{"code":"3100325","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":5579.0,"discounted_cash":3347.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO EGFR GENE MUTATION ANALYSIS, EGFRT","code_information":[{"code":"3100326","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":3288.0,"discounted_cash":1972.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO INTERLEUKIN 28B VARIANT, IL28V","code_information":[{"code":"3100327","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TPMT AND NUDT15 GENOTYPING, TPNUV","code_information":[{"code":"3100328","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1831.0,"discounted_cash":1098.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOCHROME P450 2C19 GENOTYPE, 2C19V","code_information":[{"code":"3100336","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81225","type":"HCPCS"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1692.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UGT1A1 FULL GENE SEQUENCING UGTFG","code_information":[{"code":"3100337","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":4699.0,"discounted_cash":2819.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 4; JAKXB","code_information":[{"code":"3100340","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0027U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.0,"discounted_cash":1006.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REDUCING SUBSTANCE UREDF","code_information":[{"code":"3100343","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLOW 1ST MARKER DHR","code_information":[{"code":"3100344","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":796.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MAAA NEPHROCHECK","code_information":[{"code":"3100345","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81599","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SMA CARRIER BY DEL/DUP, SMNCS","code_information":[{"code":"3100346","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":2797.0,"discounted_cash":1678.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BCELL LYMPHOMA, FISH TS INITIAL, BLYMF","code_information":[{"code":"3100347","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BCELL LYMPHOMA, FISH TS ADDTL, BLYMF","code_information":[{"code":"3100348","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":567.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO FETOMATERNAL BLEED, FLOW CYTOMETRY; FMB","code_information":[{"code":"3100349","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":2150.0,"discounted_cash":1290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CRYOPRESERVATION FOR BIOCHEMICAL CRYOB","code_information":[{"code":"3100350","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.0,"discounted_cash":852.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FIBROBLAST CULTURE FIBR","code_information":[{"code":"3100351","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":2712.0,"discounted_cash":1627.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TELOMERE DEFECTS GENE PANEL TELGP","code_information":[{"code":"3100352","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":9397.0,"discounted_cash":5638.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH SCDGP PAN LEV 9","code_information":[{"code":"3100353","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":9040.0,"discounted_cash":5424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH SCDGP LEV 6 PAN A3","code_information":[{"code":"3100354","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH SCDGP LEL 7 PAN A2","code_information":[{"code":"3100355","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":767.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH SCDGP LVL 5 PAN A3","code_information":[{"code":"3100356","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":745.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH SCDGP PAN 6","code_information":[{"code":"3100357","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2585.0,"discounted_cash":1551.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH UNLISTED A4 IBDGP","code_information":[{"code":"3100359","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":6461.0,"discounted_cash":3876.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PHAGOCYTIC PID GENE PANEL PHAGP","code_information":[{"code":"3100360","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":9397.0,"discounted_cash":5638.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO JAK2 V617F MUTATION DETECTION, B, JAK2B","code_information":[{"code":"3100362","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.0,"discounted_cash":704.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5, INITIAL, HPPAN","code_information":[{"code":"3100363","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5, ADDITIONAL, HPPAN","code_information":[{"code":"3100364","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CFTR GENE ANALYSIS; FULL GENE SEQUENCE, HPPAN","code_information":[{"code":"3100365","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81223","type":"HCPCS"}],"standard_charges":[{"gross_charge":3284.0,"discounted_cash":1970.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CFTR GENE ANALYSIS; DUPLICATION/DELETION VARIANTS, HPPAN","code_information":[{"code":"3100366","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81222","type":"HCPCS"}],"standard_charges":[{"gross_charge":2863.0,"discounted_cash":1717.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 6, HPPAN","code_information":[{"code":"3100367","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1982.0,"discounted_cash":1189.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5, MEFVZ","code_information":[{"code":"3100368","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":2898.0,"discounted_cash":1738.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MECP2 GENE ANALYSIS; FULL SEQUENCE ANALYSIS, MECPZ","code_information":[{"code":"3100369","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81302","type":"HCPCS"}],"standard_charges":[{"gross_charge":2929.0,"discounted_cash":1757.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MECP2 GENE ANALYSIS; DUPLICATION/DELETION VARIANTS, MECPZ","code_information":[{"code":"3100370","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81304","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":499.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, WDZ","code_information":[{"code":"3100371","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":9397.0,"discounted_cash":5638.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 6, CASRZ","code_information":[{"code":"3100372","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":6109.0,"discounted_cash":3665.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UNLISTED MOLECULAR PATHOLOGY PROCEDURE, TNFRZ","code_information":[{"code":"3100373","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3172.0,"discounted_cash":1903.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UNLISTED MOLECULAR PATHOLOGY PROCEDURE, C9ORF","code_information":[{"code":"3100374","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 4, LQTGP","code_information":[{"code":"3100375","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":645.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5, LQTGP","code_information":[{"code":"3100376","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1599.0,"discounted_cash":959.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, INITIAL, LQTGP","code_information":[{"code":"3100377","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.0,"discounted_cash":986.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, ADDITIONAL, LQTGP","code_information":[{"code":"3100378","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.0,"discounted_cash":986.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 8, LQTGP","code_information":[{"code":"3100379","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":4917.0,"discounted_cash":2950.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, INIT, HHTGP","code_information":[{"code":"3100380","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":6109.0,"discounted_cash":3665.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, ADDL, HHTGP","code_information":[{"code":"3100381","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":6109.0,"discounted_cash":3665.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HEREDITARY CARDIOMYOPATHY PANEL, HCMGP","code_information":[{"code":"3100382","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81439","type":"HCPCS"}],"standard_charges":[{"gross_charge":11748.0,"discounted_cash":7048.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5, BRGGP","code_information":[{"code":"3100383","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":2057.0,"discounted_cash":1234.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, BRGGP","code_information":[{"code":"3100384","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2117.0,"discounted_cash":1270.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 8, BRGGP","code_information":[{"code":"3100385","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":6335.0,"discounted_cash":3801.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEREDITARY CARDIOMYOPATHY PANEL, CCMGP","code_information":[{"code":"3100386","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81439","type":"HCPCS"}],"standard_charges":[{"gross_charge":13863.0,"discounted_cash":8317.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 9, FBN1B","code_information":[{"code":"3100387","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81408","type":"HCPCS"}],"standard_charges":[{"gross_charge":8459.0,"discounted_cash":5075.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, INITIAL, NSRGP","code_information":[{"code":"3100388","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":590.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 7, ADDITIONAL, NSRGP","code_information":[{"code":"3100389","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":590.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5, NSRGP","code_information":[{"code":"3100390","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.0,"discounted_cash":573.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 6, INITIAL, NSRGP","code_information":[{"code":"3100391","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":629.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 6, ADDITIONAL, NSRGP","code_information":[{"code":"3100392","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":629.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO NRAS, GENE ANALYSIS VARIANTS IN EXON 2&3, NSRGP","code_information":[{"code":"3100393","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81311","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FACTOR V LEIDEN(R506Q) MUT,B, F5DNA","code_information":[{"code":"3100394","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO L265P GENE MUTATION ANLYS, MYD88","code_information":[{"code":"3100395","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ALPHA-GLOBIN GENE ANLYS, ATHAL","code_information":[{"code":"3100396","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FANCONI ANEMIA, MUT ANLYS, FANCP","code_information":[{"code":"3100397","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81242","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":920.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCOGEN STORAGE DIS PNL, G6PC GENE, GSDP","code_information":[{"code":"3100398","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81250","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCOGEN STORAGE DIS PNL, LVL 4, GSDP","code_information":[{"code":"3100399","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":625.0,"discounted_cash":375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCOGEN STORAGE DIS PNL, LVL 5, GSDP","code_information":[{"code":"3100400","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":556.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCOGEN STORAGE DIS PNL, LVL 6, GSDP","code_information":[{"code":"3100401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":609.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCOGEN STORAGE DIS PNL, LVL 7 INITIAL, GSDP","code_information":[{"code":"3100402","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":571.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLYCOGEN STORAGE DIS PNL, LVL 7 ADDTL, GSDP","code_information":[{"code":"3100403","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":571.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO GLYCOGEN STORAGE DIS PNL, LVL 8, GSDP","code_information":[{"code":"3100404","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81407","type":"HCPCS"}],"standard_charges":[{"gross_charge":2854.0,"discounted_cash":1712.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO F2 GENE ANLYS, G20210A MUTATION, THRMP","code_information":[{"code":"3100405","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":356.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOTOR AND SENSORY NEUROPATHY PANEL, HMSNP","code_information":[{"code":"3100406","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81448","type":"HCPCS"}],"standard_charges":[{"gross_charge":9397.0,"discounted_cash":5638.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEREDITARY SENSORY NEUROPATHY PANEL, HSNP","code_information":[{"code":"3100407","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81448","type":"HCPCS"}],"standard_charges":[{"gross_charge":9164.0,"discounted_cash":5498.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MLH1, GENE ANALYSIS; FULL SEQUENCE, MLH1, LYNCH","code_information":[{"code":"3100408","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1807.0,"discounted_cash":1084.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MSH2, GENE ANALYSIS; FULL SEQUENCE, MSH2, LYNCH","code_information":[{"code":"3100409","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81295","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":614.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MSH6, GENE ANALYSIS; FULL SEQUENCE, MSH6, LYNCH","code_information":[{"code":"3100410","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":1030.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PMS2, GENE ANALYSIS; FULL SEQUENCE, PMS2, LYNCH","code_information":[{"code":"3100411","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1810.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH PROCEDURE LEVEL 4; LYNCH","code_information":[{"code":"3100412","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":297.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENOMIC CONSTITUTIONAL MICROARRAY; COPY NUMBER VARIANTS, NMBR, LYNCH","code_information":[{"code":"3100413","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81228","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.0,"discounted_cash":1445.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BCR/ABL1 GENE MAJOR BP, BADX","code_information":[{"code":"3100414","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":639.0,"discounted_cash":383.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BCR/ABL1 GENE MINOR BP, BADX","code_information":[{"code":"3100415","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BCR/ABL1 GENE OTHER BP, BADX","code_information":[{"code":"3100416","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":406.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS, BAKDM","code_information":[{"code":"3100417","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81170","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"discounted_cash":1128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO JAK2 GENE ANALYSIS P.VAL617PHE VARIANT, MPNR","code_information":[{"code":"3100418","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.0,"discounted_cash":704.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9, CALX,MPNR","code_information":[{"code":"3100419","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX MOLECULAR PATHOLOGY PROCEDURE LEVEL 4, MPLR, MPNR","code_information":[{"code":"3100420","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NUCLEOPHOSMIN MUTATION ANALYSIS, NPM1","code_information":[{"code":"3100421","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TARGETED GEN SEQ ANALYSIS, HEMATOLYMPHOID, NGAML","code_information":[{"code":"3100422","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":7939.0,"discounted_cash":4763.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5, CPT2Z","code_information":[{"code":"3100423","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":5579.0,"discounted_cash":3347.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX TISSUE CULTURE SKIN/BIOPSY, CULFB, CPT2Z","code_information":[{"code":"3100424","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":1609.0,"discounted_cash":965.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX CELL CRYOPRESERVATION, CULFB STORAGE,CPT2Z","code_information":[{"code":"3100425","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FABRY DISEASE, FULL GENE ANALYSIS, FABRZ","code_information":[{"code":"3100426","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":4358.0,"discounted_cash":2614.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GALT GENE, FULL GENE ANALYSIS, GALTZ","code_information":[{"code":"3100427","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4699.0,"discounted_cash":2819.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SCAD DEFICIENCY, FULL GENE ANALYSIS, SCADZ","code_information":[{"code":"3100428","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":5639.0,"discounted_cash":3383.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGK, IMMUNOGLOBULIN GENE REARRANGEMENT ANALYSIS, IGK BCGR","code_information":[{"code":"3100429","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IGH, IMMUNOGLOBULIN GENE REARRANGEMENT ANALYSIS, IGH BCGR","code_information":[{"code":"3100430","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":683.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO KIT, GENE ANALYSIS D816 VARIANT, KITB","code_information":[{"code":"3100431","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81273","type":"HCPCS"}],"standard_charges":[{"gross_charge":2467.0,"discounted_cash":1480.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO KIT, GENE ANALYSIS D816 VARIANT, KITBM","code_information":[{"code":"3100432","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81273","type":"HCPCS"}],"standard_charges":[{"gross_charge":2467.0,"discounted_cash":1480.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO JAK2 GENE ANALYSIS, P.VAL617PHE VARIANT, JAK2M","code_information":[{"code":"3100433","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.0,"discounted_cash":704.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MPL EXON 10 MUTATION DETECTION, MPLM","code_information":[{"code":"3100434","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEREDITARY MOTOR NEUROPATHY PANEL, HMNP","code_information":[{"code":"3100435","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81448","type":"HCPCS"}],"standard_charges":[{"gross_charge":10338.0,"discounted_cash":6202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PMP22 GENE, DELETION/DUPLICATION, PMPDD","code_information":[{"code":"3100436","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81324","type":"HCPCS"}],"standard_charges":[{"gross_charge":2302.0,"discounted_cash":1381.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TPMT GENE ANALYSIS, TPNUV","code_information":[{"code":"3100437","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0034U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2014.0,"discounted_cash":1208.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGEN MICROARRAY COPY NMBR, BRST6","code_information":[{"code":"3100439","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81228","type":"HCPCS"}],"standard_charges":[{"gross_charge":2316.0,"discounted_cash":1389.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PMS2 GENE LARGE DEL/DUP, LYNCH","code_information":[{"code":"3100440","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81319","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HUNTINGTON DISEASE  HAD LAB TEST","code_information":[{"code":"3100441","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1410.0,"discounted_cash":846.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SMA CARRIER SCREEN SMNCS LAB TEST","code_information":[{"code":"3100442","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":2797.0,"discounted_cash":1678.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MYD88 L265P GENE MUTATION LAB TEST","code_information":[{"code":"3100443","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TSTG SEVERE INH COND, AUTOP, GNPLT","code_information":[{"code":"3100444","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81443","type":"HCPCS"}],"standard_charges":[{"gross_charge":10572.0,"discounted_cash":6343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRCA1&2 SEQ & FULL DUP/DEL, BRCRC","code_information":[{"code":"3100445","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":3647.0,"discounted_cash":2188.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FLOW TC 1 MARKER, CK53S","code_information":[{"code":"3100447","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1693.0,"discounted_cash":1015.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLOW CYTO CELL SORTING BM, PCPDS","code_information":[{"code":"3100448","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":451.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTO DNA PROBE FISH, PCPDS","code_information":[{"code":"3100449","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":601.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTO DNA PROBE, FISH, ADDL, PCPDS","code_information":[{"code":"3100450","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":601.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX FLOW BM, CSMRT","code_information":[{"code":"3100451","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":451.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX MSMART INT'L, MPCDS","code_information":[{"code":"3100452","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":601.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX MSMART ADD'L, MPCDS","code_information":[{"code":"3100453","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":601.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, INT'L, FBCEL","code_information":[{"code":"3100454","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADD'L, FBCEL","code_information":[{"code":"3100455","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":129.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300, FBCEL","code_information":[{"code":"3100456","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":309.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS 100-300, FBCEL","code_information":[{"code":"3100457","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":309.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, INT'L, FFMDS","code_information":[{"code":"3100458","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, ADD'L, FFMDS","code_information":[{"code":"3100459","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300, FFMDS","code_information":[{"code":"3100460","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS 100-300, FFMDS","code_information":[{"code":"3100461","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":202.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CHROM TISS CULTURE BONE MARROW, CHRBM","code_information":[{"code":"3100462","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX HEMOGLOBIN F, RBC DIST, HPFH","code_information":[{"code":"3100467","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":388.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX JAK2 EXON 12-15 SEQ, JAKXR","code_information":[{"code":"3100471","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0027U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.0,"discounted_cash":874.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRCA1&2 GEN FULL SEQ DUP/DEL, BRCA1/2","code_information":[{"code":"3100473","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":5542.0,"discounted_cash":3325.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CYTP SMRS OTHER SOURCE MORE THAN 5 SLIDES","code_information":[{"code":"3100474","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88162","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLL FISH CYTOGEN DNA PRB INT'L, CLLDF","code_information":[{"code":"3100481","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLL FISH CYTOGEN DNA PRB ADD'L, CLLDF","code_information":[{"code":"3100482","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":70.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CLL FISH CYTOGENETICS 100-300 PRB, CLLDF","code_information":[{"code":"3100483","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CLL FISH CYTOGENETICS 100-300 PRB, CLLDF","code_information":[{"code":"3100484","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":147.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, CLLMF","code_information":[{"code":"3100485","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, CLLMF","code_information":[{"code":"3100486","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.0,"discounted_cash":249.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300 PROBES, CLLMF","code_information":[{"code":"3100487","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO SPINAL MUSCULAR ATROPHY GENE, SMNDX","code_information":[{"code":"3100488","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":852.0,"discounted_cash":511.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX ALPHA GLOBIN GENE SEQUENCE, WASQR","code_information":[{"code":"3100489","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81259","type":"HCPCS"}],"standard_charges":[{"gross_charge":1598.0,"discounted_cash":958.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX FLOWCYTO HBG, HPFH","code_information":[{"code":"3100490","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":367.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IBDGP PIDG PANEL, IBDGP","code_information":[{"code":"3100491","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81443","type":"HCPCS"}],"standard_charges":[{"gross_charge":12179.0,"discounted_cash":7307.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, BLPMF","code_information":[{"code":"3100492","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADD'L, BLPMF","code_information":[{"code":"3100493","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300, BLPMF","code_information":[{"code":"3100494","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE INTL, AMLAF, AMLFA","code_information":[{"code":"3100495","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADDL, AMLAF, AMLFA","code_information":[{"code":"3100496","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":72.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300 INTL, AMLAF, AMLFA","code_information":[{"code":"3100497","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS 100-300 ADDL, AMLAF, AMLFA","code_information":[{"code":"3100498","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, AMLMF","code_information":[{"code":"3100499","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADD'L, AMLMF","code_information":[{"code":"3100500","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300, AMLMF","code_information":[{"code":"3100501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":382.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE INTL AMLPF, AMLFP","code_information":[{"code":"3100502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADDL, AMLPF, AMLFP","code_information":[{"code":"3100503","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300 INTL, AMLPF, AMLFP","code_information":[{"code":"3100504","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":211.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS 100-300 ADDL, AMLPF, AMLFP","code_information":[{"code":"3100505","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.0,"discounted_cash":211.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, BALAF","code_information":[{"code":"3100506","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADD'L, BALAF","code_information":[{"code":"3100507","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300, BALAF","code_information":[{"code":"3100508","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":340.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS 100-300 ADD'L, BALAF","code_information":[{"code":"3100509","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":340.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE INTL, BALPF, BALFP","code_information":[{"code":"3100510","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADLL, BALPF, BALFP","code_information":[{"code":"3100511","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE INTL, BALPF, BALFP","code_information":[{"code":"3100512","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS 100-300 ADDL, BALPF, BALFP","code_information":[{"code":"3100513","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE, BALMF","code_information":[{"code":"3100514","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":212.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADD'L, BALMF","code_information":[{"code":"3100515","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":212.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300, BALMF","code_information":[{"code":"3100516","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":406.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE INTL, PHLDF, PHLFD","code_information":[{"code":"3100517","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":153.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADDL, PHLDF, PHLFD","code_information":[{"code":"3100518","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":153.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300 INTL, PHLDF, PHLFD","code_information":[{"code":"3100519","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS 100-300 ADDL, PHLDF, PHLFD","code_information":[{"code":"3100520","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX MSMART INT'L, MPCDS","code_information":[{"code":"3100521","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO REFLEX MSMART ADD'L, MPCDS","code_information":[{"code":"3100522","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO REFLEX MSMART, MPCDS","code_information":[{"code":"3100523","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTO DNA PROBE FISH INT'L, PCPDS","code_information":[{"code":"3100524","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTO DNA PROBE FISH ADD'L, PCPDS","code_information":[{"code":"3100525","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":334.2,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTO DNA PROBE FISH, PCPDS","code_information":[{"code":"3100526","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88274","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PROMOTER ANALYSIS TUMOR, TERT","code_information":[{"code":"3100527","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81345","type":"HCPCS"}],"standard_charges":[{"gross_charge":3543.0,"discounted_cash":2125.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TISSUE CULTURE BONE MARROW, CHRHB","code_information":[{"code":"3100528","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR CYTOGENETICS, HEMMF","code_information":[{"code":"3100529","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1645.0,"discounted_cash":987.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLEC CYTOGENETICS DNA PROBE EA INT'L, HEMMF","code_information":[{"code":"3100530","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLEC CYTOGENETICS DNA PROBE EA ADD'L, HEMMF","code_information":[{"code":"3100531","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO HIV GENO DRUG RESIST, HIVDR","code_information":[{"code":"3100532","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0219U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1682.0,"discounted_cash":1009.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO BRCA1/2 FULL GENE ANALYSIS, HBOCZ","code_information":[{"code":"3100535","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":8252.0,"discounted_cash":4951.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MDS DIAGNOSTIC FISH INT'L, MDSDF","code_information":[{"code":"3100536","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MDS DIAGNOSTIC FISH ADD'L, MDSDF","code_information":[{"code":"3100537","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO MYELODYSPLASTIC SYN INT'L, MDSDF","code_information":[{"code":"3100538","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MYELODYSPLASTIC SYN ADD'L, MDSDF","code_information":[{"code":"3100539","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS DNA PROBE INT'L, MDSMF","code_information":[{"code":"3100540","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO CYTOGENETICS DNA PROBE ADD'L, MDSMF","code_information":[{"code":"3100541","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":154.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO CYTOGENETICS 100-300, MDSMF","code_information":[{"code":"3100542","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO HEREDITARY ERYTHROCYTOSIS MUT, HEMP","code_information":[{"code":"3100543","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2535.0,"discounted_cash":1521.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOPATH VHL GENE ERYTHROCYTOSIS MUT, VHLE","code_information":[{"code":"3100544","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":1572.0,"discounted_cash":943.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR CYTOGENETICS, CMAFF","code_information":[{"code":"3100545","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":235.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO MOLECULAR CYTOGENETICS, CMAFF","code_information":[{"code":"3100546","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":235.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SO BPGM FULL GENE SEQUENCING, BPGMM","code_information":[{"code":"3100547","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.0,"discounted_cash":1061.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO WILSON DISEASE ATP7B FULL GENE SEQ, WNDZ","code_information":[{"code":"3100548","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":10260.0,"discounted_cash":6156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PANCREATIC CYST CYTO, INTERPACE","code_information":[{"code":"3100549","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":589.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UGT1A1 FULL GENE SEQUENCING UGTFG","code_information":[{"code":"3100550","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3733.0,"discounted_cash":2239.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TERT PROMOTER ANALYSIS TUMOR, TERTT","code_information":[{"code":"3100551","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81345","type":"HCPCS"}],"standard_charges":[{"gross_charge":3270.0,"discounted_cash":1962.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IDH1/2 MUTATIONS ANALYSIS TUMOR, IDHT","code_information":[{"code":"3100552","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2357.0,"discounted_cash":1414.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TELOMERE DISORDERS GENE PANEL, TELDP","code_information":[{"code":"3100553","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81443","type":"HCPCS"}],"standard_charges":[{"gross_charge":8841.0,"discounted_cash":5304.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO KARIUS TEST, KARIUS LAB","code_information":[{"code":"3100554","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"gross_charge":5895.0,"discounted_cash":3537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TERT GENE TARGETED SEQ ANALYSIS, TERTD","code_information":[{"code":"3100555","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81345","type":"HCPCS"}],"standard_charges":[{"gross_charge":3908.0,"discounted_cash":2344.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GALACTOSEMIA MUT PANEL, GALMP","code_information":[{"code":"3100556","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.0,"discounted_cash":1040.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO DPYD FULL GENE SEQUENCING, DPYDZ","code_information":[{"code":"3100557","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":2190.0,"discounted_cash":1314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO UGT1A1 FULL GENE SEQ MOPATH LEV 5, UGTFZ","code_information":[{"code":"3100558","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3468.0,"discounted_cash":2080.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PR COG CHROMO HEMATOLOGIC, COGBM","code_information":[{"code":"3100559","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.0,"discounted_cash":711.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"POLYGENIC RISK SCORE - POLY","code_information":[{"code":"3100560","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81599","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ONCOMINE MYELOID PANEL","code_information":[{"code":"3100562","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3236.0,"discounted_cash":1941.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO FLOW 1ST MARKER, HEMATOLOGICS, HMRD","code_information":[{"code":"3100563","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":3784.0,"discounted_cash":2270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO G6PD FULL GENE SEQUENCE, G6PDZ","code_information":[{"code":"3100564","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81249","type":"HCPCS"}],"standard_charges":[{"gross_charge":2499.0,"discounted_cash":1499.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO GLA GENE ANALYSIS, GLA","code_information":[{"code":"3100565","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":5797.0,"discounted_cash":3478.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO ACADVL GENE ANALYSIS, ACADV","code_information":[{"code":"3100566","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":5797.0,"discounted_cash":3478.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO IDUA GENE ANALYSIS, IDUA","code_information":[{"code":"3100567","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":5797.0,"discounted_cash":3478.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO PRIMARY CILIARY DYSKINESIA GENE PANEL, PCDGG","code_information":[{"code":"3100568","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":9746.0,"discounted_cash":5847.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO NEURO-ONC PANEL NONCM","code_information":[{"code":"3100569","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81457","type":"HCPCS"}],"standard_charges":[{"gross_charge":9010.0,"discounted_cash":5406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SO TARGETED RNA SEQ, MCRSP","code_information":[{"code":"3100570","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81456","type":"HCPCS"}],"standard_charges":[{"gross_charge":11719.0,"discounted_cash":7031.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70015 CISTERNOGRAPHY POSITIVE CONTRAST","code_information":[{"code":"3200001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70015","type":"HCPCS"}],"standard_charges":[{"gross_charge":2372.0,"discounted_cash":1423.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70030 EYE FOR DETECTION FB-BLT","code_information":[{"code":"3200002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":376.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 70100 MANDIBLE PARTIAL < 4V","code_information":[{"code":"3200003","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":429.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70110 MANDIBLE COMPLETE, MIN 4V","code_information":[{"code":"3200004","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70120 MASTOIDS <3 VIEWS, EACH SIDE-LT","code_information":[{"code":"3200005","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70120","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":395.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 70120 MASTOIDS <3 VIEWS, EACH SIDE-RT","code_information":[{"code":"3200006","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70120","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":395.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 70120 MASTOIDS <3 VIEWS, EACH SIDE-BLT","code_information":[{"code":"3200007","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70120","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":592.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 70130 MASTOIDS COMPLETE, MIN 3V EA SIDE-LT","code_information":[{"code":"3200008","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 70130 MASTOIDS COMPLETE, MIN 3V EA SIDE-RT","code_information":[{"code":"3200009","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 70130 MASTOIDS COMPLETE, MIN 3V EA SIDE-BLT","code_information":[{"code":"3200010","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1390.0,"discounted_cash":834.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 70150 FACIAL BONES COMPLETE, MIN 3V","code_information":[{"code":"3200011","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":601.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70160 NASAL BONES COMPLETE, MIN 3V","code_information":[{"code":"3200012","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70200 ORBITS COMPLETE, MIN 4V","code_information":[{"code":"3200013","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.0,"discounted_cash":573.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70210 SINUSES PARANASAL < 3V","code_information":[{"code":"3200014","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":278.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70220 SINUSES PARANASAL, COMPLETE, MIN 3V","code_information":[{"code":"3200015","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"discounted_cash":459.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70250 SKULL < 4V","code_information":[{"code":"3200016","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":415.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70260 SKULL COMPLETE, MIN 4V","code_information":[{"code":"3200017","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":579.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70328 TMJ JOINT, OPEN & CLOSED, UNILAT-LT","code_information":[{"code":"3200020","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":413.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 70328 TMJ JOINT, OPEN & CLOSED, UNILAT-RT","code_information":[{"code":"3200021","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":413.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 70330 TMJ JOINT, OPEN & CLOSED, BILATERAL","code_information":[{"code":"3200022","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70355 ORTHOPANTOGRAM","code_information":[{"code":"3200023","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70355","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.0,"discounted_cash":1518.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70360 NECK SOFT TISSUE","code_information":[{"code":"3200024","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":356.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70371 COMPLEX PHAR/SPEECH EVAL BY CINE/VIDEO","code_information":[{"code":"3200025","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70371","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.0,"discounted_cash":898.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70380 SALIVARY GLAND-CALCULUS RAD EXAM","code_information":[{"code":"3200026","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70380","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":280.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70390 SIALOGRAM","code_information":[{"code":"3200027","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70390","type":"HCPCS"}],"standard_charges":[{"gross_charge":1304.0,"discounted_cash":782.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71100 RIBS UNILAT, 2 VIEWS-LT","code_information":[{"code":"3200040","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":432.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 71100 RIBS UNILAT, 2 VIEWS-RT","code_information":[{"code":"3200041","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":432.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 71101 RIBS UNILAT, MIN 3V, W/ PA CHEST-LT","code_information":[{"code":"3200042","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 71101 RIBS UNILAT, MIN 3V, W/ PA CHEST-RT","code_information":[{"code":"3200043","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 71110 RIBS BILAT 3V","code_information":[{"code":"3200044","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.0,"discounted_cash":719.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71111 RIBS BILAT, MIN 4V, W/ PA CHEST","code_information":[{"code":"3200045","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.0,"discounted_cash":885.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71120 STERNUM MIN 2V","code_information":[{"code":"3200046","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71130 STERNOCLAVICULAR JOINT(S), MIN 3V","code_information":[{"code":"3200047","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.0,"discounted_cash":432.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72020 SPINE 1V, LUMBAR","code_information":[{"code":"3200049","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72020 SPINE 1V, THORACIC","code_information":[{"code":"3200050","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72020 SPINE 1V, CERVICAL","code_information":[{"code":"3200051","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":354.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72020 SPINE 1V, LUMBAR-PORTABLE","code_information":[{"code":"3200052","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":357.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72020 SPINE 1V, THORACIC-PORTABLE","code_information":[{"code":"3200053","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":381.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72020 SPINE 1V, CERVICAL-PORTABLE","code_information":[{"code":"3200054","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":354.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72040 SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"3200055","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72040 SPINE CERVICAL 2 OR 3 VIEWS PORTABLE","code_information":[{"code":"3200056","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":486.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72050 SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"3200057","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":599.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72052 SPINE CERVICAL, 6 OR MORE VIEWS","code_information":[{"code":"3200058","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":659.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72070 SPINE THORACIC 2 VIEWS","code_information":[{"code":"3200060","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":476.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72070 SPINE THORACIC 2 VIEWS-PORTABLE","code_information":[{"code":"3200061","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.0,"discounted_cash":476.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72072 SPINE THORACIC 3 VIEWS","code_information":[{"code":"3200062","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":547.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72074 SPINE THORACIC COMPLETE, MIN 4V","code_information":[{"code":"3200063","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.0,"discounted_cash":591.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72100 SPINE LUMBAR 2 OR 3 VIEWS","code_information":[{"code":"3200066","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":489.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72100 SPINE LUMBAR 2 OR 3 VIEWS-PORTABLE","code_information":[{"code":"3200067","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":489.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72110 SPINE LUMBAR MIN 4 VIEWS","code_information":[{"code":"3200068","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":562.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72114 SPINE LUMBAR W/BEND MINIMUM 6 VIEWS","code_information":[{"code":"3200069","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72120 SPINE LUMBAR BEND ONLY, 2 OR 3 VIEWS","code_information":[{"code":"3200070","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":816.0,"discounted_cash":489.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72170 PELVIS 1 OR 2 VIEWS","code_information":[{"code":"3200071","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72170 PELVIS 1 OR 2 VIEWS-PORTABLE","code_information":[{"code":"3200072","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":453.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72190 PELVIS COMPLETE, MIN 3V","code_information":[{"code":"3200073","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.0,"discounted_cash":505.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72200 SACROILIAC JOINTS <3 VIEWS","code_information":[{"code":"3200074","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72202 SACROILIAC JOINTS MIN 3V","code_information":[{"code":"3200075","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72220 SACRUM & COCCYX MIN 2V","code_information":[{"code":"3200076","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.0,"discounted_cash":416.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72240 MYELOGRAPHY CERVICAL","code_information":[{"code":"3200077","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1677.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72255 MYELOGRAPHY THORACIC","code_information":[{"code":"3200078","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1677.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72265 MYELOGRAPHY LUMBAR","code_information":[{"code":"3200079","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":2795.0,"discounted_cash":1677.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72270 MYELOGRAPHY 2 OR > REGIONS","code_information":[{"code":"3200080","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":2155.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72285 DISKOGRAPHY CERVICAL OR THORACIC","code_information":[{"code":"3200082","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72285","type":"HCPCS"}],"standard_charges":[{"gross_charge":6917.0,"discounted_cash":4150.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72295 DISKOGRAPHY LUMBAR","code_information":[{"code":"3200084","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72295","type":"HCPCS"}],"standard_charges":[{"gross_charge":5954.0,"discounted_cash":3572.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73000 CLAVICAL   COMPLETE-BLT","code_information":[{"code":"3200085","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":553.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73000 CLAVICAL   COMPLETE-LT","code_information":[{"code":"3200086","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":370.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73000 CLAVICAL   COMPLETE-RT","code_information":[{"code":"3200087","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":370.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73010 SCAPULA  COMPLETE-BLT","code_information":[{"code":"3200088","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.0,"discounted_cash":651.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73010 SCAPULA  COMPLETE-LT","code_information":[{"code":"3200089","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":436.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73010 SCAPULA  COMPLETE-RT","code_information":[{"code":"3200090","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":436.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73020 SHOULDER 1V-BLT","code_information":[{"code":"3200091","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":490.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73020 SHOULDER 1V-LT","code_information":[{"code":"3200092","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":329.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73020 SHOULDER 1V-RT","code_information":[{"code":"3200093","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":329.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73030 SHOULDER COMPLETE, MIN 2V-BLT","code_information":[{"code":"3200094","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":613.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73030 SHOULDER COMPLETE, MIN 2V-LT","code_information":[{"code":"3200095","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":411.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73030 SHOULDER COMPLETE, MIN 2V-RT","code_information":[{"code":"3200096","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":411.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73040 SHOULDER ARTHROGRAM-LT","code_information":[{"code":"3200097","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":976.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73040 SHOULDER ARTHROGRAM-RT","code_information":[{"code":"3200098","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":976.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73050 AC JOINTS BIL, W/O OR W/ WEIGHTS","code_information":[{"code":"3200099","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73060 HUMERUS MIN 2V-BLT","code_information":[{"code":"3200100","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":571.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73060 HUMERUS MIN 2V-LT","code_information":[{"code":"3200101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":382.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73060 HUMERUS MIN 2V-RT","code_information":[{"code":"3200102","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":382.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73070 ELBOW 2 VIEWS-BLT","code_information":[{"code":"3200103","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":507.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73070 ELBOW 2 VIEWS-LT","code_information":[{"code":"3200104","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":337.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73070 ELBOW 2 VIEWS-RT","code_information":[{"code":"3200105","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":337.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73080 ELBOW COMPLETE, MIN 3V-BLT","code_information":[{"code":"3200106","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":634.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73080 ELBOW COMPLETE, MIN 3V-LT","code_information":[{"code":"3200107","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":423.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73080 ELBOW COMPLETE, MIN 3V-RT","code_information":[{"code":"3200108","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":423.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73085 ELBOW ARTHROGRAM-LT","code_information":[{"code":"3200109","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1359.0,"discounted_cash":815.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73085 ELBOW ARTHROGRAM-RT","code_information":[{"code":"3200110","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73085","type":"HCPCS"}],"standard_charges":[{"gross_charge":1359.0,"discounted_cash":815.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73090 FOREARM 2 VIEWS-BLT","code_information":[{"code":"3200111","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":551.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73090 FOREARM 2 VIEWS-LT","code_information":[{"code":"3200112","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":369.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73090 FOREARM 2 VIEWS-RT","code_information":[{"code":"3200113","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":369.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73092 UPPER EXTREMITY, INFANT, MIN 2V-BLT","code_information":[{"code":"3200114","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":370.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73092 UPPER EXTREMITY, INFANT, MIN 2V-LT","code_information":[{"code":"3200115","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":248.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73092 UPPER EXTREMITY, INFANT, MIN 2V-RT","code_information":[{"code":"3200116","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":248.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73100 WRIST 2 VIEWS-BLT","code_information":[{"code":"3200117","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":499.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73100 WRIST 2 VIEWS-LT","code_information":[{"code":"3200118","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":333.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73100 WRIST 2 VIEWS-RT","code_information":[{"code":"3200119","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":333.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73110 WRIST COMPLETE, MIN 3V-BLT","code_information":[{"code":"3200120","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.0,"discounted_cash":621.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73110 WRIST COMPLETE, MIN 3V-LT","code_information":[{"code":"3200121","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":415.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73110 WRIST COMPLETE, MIN 3V-RT","code_information":[{"code":"3200122","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":415.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73115 WRIST ARTHROGRAM-LT","code_information":[{"code":"3200123","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1479.0,"discounted_cash":887.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73115 WRIST ARTHROGRAM-RT","code_information":[{"code":"3200124","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73115","type":"HCPCS"}],"standard_charges":[{"gross_charge":1479.0,"discounted_cash":887.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73120 HAND 2 VIEWS-BLT","code_information":[{"code":"3200125","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73120 HAND 2 VIEWS-LT","code_information":[{"code":"3200126","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":354.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73120 HAND 2 VIEWS-RT","code_information":[{"code":"3200127","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":354.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73130 HAND MIN 3 VIEWS-BLT","code_information":[{"code":"3200128","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1105.0,"discounted_cash":663.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73130 HAND MIN 3 VIEWS-LT","code_information":[{"code":"3200129","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":441.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73130 HAND MIN 3 VIEWS-RT","code_information":[{"code":"3200130","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":441.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73140 FINGER(S) MIN 2 VIEWS","code_information":[{"code":"3200131","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":306.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73525 HIP ARTHROGRAM-LT","code_information":[{"code":"3200137","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":1019.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73525 HIP ARTHROGRAM-RT","code_information":[{"code":"3200138","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1699.0,"discounted_cash":1019.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73560 KNEE 1 OR 2 VIEWS-BLT","code_information":[{"code":"3200147","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.0,"discounted_cash":562.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73560 KNEE 1 OR 2 VIEWS-LT","code_information":[{"code":"3200148","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":375.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73560 KNEE 1 OR 2 VIEWS-RT","code_information":[{"code":"3200149","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":375.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73562 KNEE 3 VIEWS-BLT","code_information":[{"code":"3200150","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.0,"discounted_cash":700.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73562 KNEE 3 VIEWS-LT","code_information":[{"code":"3200151","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":466.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73562 KNEE 3 VIEWS-RT","code_information":[{"code":"3200152","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":466.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73564 KNEE COMPLETE, MIN 4V-BLT","code_information":[{"code":"3200153","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":877.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73564 KNEE COMPLETE, MIN 4V-LT","code_information":[{"code":"3200154","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":586.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73564 KNEE COMPLETE, MIN 4V-RT","code_information":[{"code":"3200155","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":586.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73565 KNEES AP BILATERAL STANDING","code_information":[{"code":"3200156","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73580 KNEE ARTHROGRAM-LT","code_information":[{"code":"3200157","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.0,"discounted_cash":1006.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73580 KNEE ARTHROGRAM-RT","code_information":[{"code":"3200158","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.0,"discounted_cash":1006.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73590 TIBIA & FIBULA 2 VIEWS-BLT","code_information":[{"code":"3200159","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":586.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73590 TIBIA & FIBULA 2 VIEWS-LT","code_information":[{"code":"3200160","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":392.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73590 TIBIA & FIBULA 2 VIEWS-RT","code_information":[{"code":"3200161","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":392.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73592 LOWER EXTREMITY, INFANT, MIN 2V-BLT","code_information":[{"code":"3200162","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73592 LOWER EXTREMITY, INFANT, MIN 2V-LT","code_information":[{"code":"3200163","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":257.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73592 LOWER EXTREMITY, INFANT, MIN 2V-RT","code_information":[{"code":"3200164","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":257.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73600 ANKLE 2 VIEWS-BLT","code_information":[{"code":"3200165","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":866.0,"discounted_cash":519.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73600 ANKLE 2 VIEWS-LT","code_information":[{"code":"3200166","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":347.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73600 ANKLE 2 VIEWS-RT","code_information":[{"code":"3200167","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":347.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73610 ANKLE COMPLETE, MIN 3V-BLT","code_information":[{"code":"3200168","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1083.0,"discounted_cash":649.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73610 ANKLE COMPLETE, MIN 3V-LT","code_information":[{"code":"3200169","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73610 ANKLE COMPLETE, MIN 3V-RT","code_information":[{"code":"3200170","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73615 ANKLE ARTHROGRAM-LT","code_information":[{"code":"3200171","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.0,"discounted_cash":921.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73615 ANKLE ARTHROGRAM-RT","code_information":[{"code":"3200172","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.0,"discounted_cash":921.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73620 FOOT 2 VIEWS-BLT","code_information":[{"code":"3200173","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":875.0,"discounted_cash":525.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73620 FOOT 2 VIEWS-LT","code_information":[{"code":"3200174","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":352.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73620 FOOT 2 VIEWS-RT","code_information":[{"code":"3200175","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":352.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73630 FOOT COMPLETE, MIN 3V-BLT","code_information":[{"code":"3200176","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1091.0,"discounted_cash":654.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73630 FOOT COMPLETE, MIN 3V-LT","code_information":[{"code":"3200177","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":439.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73630 FOOT COMPLETE, MIN 3V-RT","code_information":[{"code":"3200178","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":732.0,"discounted_cash":439.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73650 CALCANEUS MIN 2V-BLT","code_information":[{"code":"3200179","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":510.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73650 CALCANEUS MIN 2V-LT","code_information":[{"code":"3200180","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":339.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73650 CALCANEUS MIN 2V-RT","code_information":[{"code":"3200181","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":339.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73660 TOE(S) MIN  2V","code_information":[{"code":"3200182","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":301.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74022 ABDOMEN ACUTE SERIES, COMPLETE","code_information":[{"code":"3200186","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.0,"discounted_cash":625.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74210 PHARYNX AND/OR CERVIAL ESOPHAGUS","code_information":[{"code":"3200187","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74210","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":590.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74220 ESOPHAGUS","code_information":[{"code":"3200188","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":645.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74230 SWALLOW FUNCTION W/ CINE/VIDEO","code_information":[{"code":"3200189","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.0,"discounted_cash":715.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74250 SMALL INTESTINE","code_information":[{"code":"3200197","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":787.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74251 SMALL BOWEL VIA ENTEROCLYSIS TUBE","code_information":[{"code":"3200198","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74251","type":"HCPCS"}],"standard_charges":[{"gross_charge":1852.0,"discounted_cash":1111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74270 BARIUM ENEMA W/ OR W/O KUB","code_information":[{"code":"3200199","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1525.0,"discounted_cash":915.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74280 BAR ENEMA W/ AC BAR W/ OR W/O KUB","code_information":[{"code":"3200200","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.0,"discounted_cash":1212.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74283 THERAPEUTIC ENEMA, CONTRAST OR AIR","code_information":[{"code":"3200201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1485.0,"discounted_cash":891.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74290 CHOLECYSTOGRAPHY ORAL","code_information":[{"code":"3200202","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.0,"discounted_cash":414.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74300 CHOLANGIO/PANCREAT, INTRAOPERATIVE","code_information":[{"code":"3200203","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1449.0,"discounted_cash":869.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74301 CHOLANG/PANCRE,EA ADDL SET,INTRAOP","code_information":[{"code":"3200204","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74301","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"discounted_cash":545.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74328 ERCP BILIARY DUCTAL SYSTEM","code_information":[{"code":"3200208","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.0,"discounted_cash":1182.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74329 ERCP PANCREATIC DUCTAL SYSTEM","code_information":[{"code":"3200209","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74329","type":"HCPCS"}],"standard_charges":[{"gross_charge":2090.0,"discounted_cash":1254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74330 ERCP BILIARY & PANCREATIC DUCTAL SYS","code_information":[{"code":"3200210","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2953.0,"discounted_cash":1771.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74340 INTRO OF LONG GI TUBE","code_information":[{"code":"3200211","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":814.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74355 PERC PLACE OF ENTEROCLYSIS TUBE","code_information":[{"code":"3200212","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74355","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.0,"discounted_cash":1178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74360 INTRALUMINAL DILI, STRICTURES/OBSTR","code_information":[{"code":"3200213","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1522.0,"discounted_cash":913.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74363 PERC TRANSHEP DILI, BILI W/ OR W/O STNT","code_information":[{"code":"3200214","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74363","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":2217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74400 UROGRAM (IVP), ADULT W/ TOMO","code_information":[{"code":"3200215","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74400 UROGRAM (IVP), ADULT W/O TOMO","code_information":[{"code":"3200216","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1525.0,"discounted_cash":915.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74400 UROGRAM (IVP), PEDIATRIC W/ TOMO","code_information":[{"code":"3200217","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74400 UROGRAM (IVP), PEDIATRIC W/O TOMO","code_information":[{"code":"3200218","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74420 UROGRAM, RETROGRADE, W/ OR W/O KUB","code_information":[{"code":"3200219","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":976.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74430 CYSTOGRAPHY MIN 3V-FAC","code_information":[{"code":"3200222","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":786.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74450 URETHROCYSTOGRAM, RETROGRADE","code_information":[{"code":"3200223","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.0,"discounted_cash":898.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74455 URETHROCYSTOGRAM VOIDING","code_information":[{"code":"3200224","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1479.0,"discounted_cash":887.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74740 HYSTEROSALPINGOGRAM","code_information":[{"code":"3200228","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1613.0,"discounted_cash":967.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74742 RANSCERVICAL CATH OF FALLOPIAN TUBE","code_information":[{"code":"3200229","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74742","type":"HCPCS"}],"standard_charges":[{"gross_charge":1179.0,"discounted_cash":707.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75605 AORTOGRAM THORACIC, SERIAL","code_information":[{"code":"3200230","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75605","type":"HCPCS"}],"standard_charges":[{"gross_charge":6089.0,"discounted_cash":3653.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75625 AORTOGRAM ABDOMINAL, SERIAL","code_information":[{"code":"3200231","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6701.0,"discounted_cash":4020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75630 AORTOGRAM ABD W/BIL ILIOFEM RUNOFF","code_information":[{"code":"3200232","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":6701.0,"discounted_cash":4020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75705 ANGIOGRAM SPINAL SELECTIVE","code_information":[{"code":"3200247","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75705","type":"HCPCS"}],"standard_charges":[{"gross_charge":7533.0,"discounted_cash":4519.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75710 ANGIOGRAM EXTREMITY UNILAT-LT","code_information":[{"code":"3200248","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":6701.0,"discounted_cash":4020.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 75710 ANGIOGRAM EXTREMITY UNILAT-RT","code_information":[{"code":"3200250","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":6701.0,"discounted_cash":4020.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 75716 ANGIOGRAM EXTREMITY BILAT","code_information":[{"code":"3200252","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":7243.0,"discounted_cash":4345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75726 ANGIOGRAM VISCERAL SELECTIVE","code_information":[{"code":"3200256","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":7533.0,"discounted_cash":4519.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANGIOGRAM ADRENAL UNILAT SELECT-LT","code_information":[{"code":"3200257","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75731","type":"HCPCS"}],"standard_charges":[{"gross_charge":6681.0,"discounted_cash":4008.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ANGIOGRAM ADRENAL UNILAT SELECT-RT","code_information":[{"code":"3200258","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75731","type":"HCPCS"}],"standard_charges":[{"gross_charge":6681.0,"discounted_cash":4008.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ANGIOGRAM ADRENAL BILAT SELECT","code_information":[{"code":"3200259","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75733","type":"HCPCS"}],"standard_charges":[{"gross_charge":5393.0,"discounted_cash":3235.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75736 ANGIOGRAM PELVIC SELECTIVE","code_information":[{"code":"3200260","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":6701.0,"discounted_cash":4020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANGIOGRAM PULMONARY UNILAT SEL-LT","code_information":[{"code":"3200261","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":6131.0,"discounted_cash":3678.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ANGIOGRAM PULMONARY UNILAT SEL-RT","code_information":[{"code":"3200262","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":6131.0,"discounted_cash":3678.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 75743 ANGIOGRAM PULMONARY BILAT SELECT","code_information":[{"code":"3200263","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":6024.0,"discounted_cash":3614.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75774 ANGIOGRAM SELECT EACH ADDL VESSEL","code_information":[{"code":"3200265","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":2587.0,"discounted_cash":1552.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75809 SHUNT-PREV PLACE-INDWELL","code_information":[{"code":"3200267","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.0,"discounted_cash":771.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75809 SHUNTOGRAM, PREVIOUSLY PLACED","code_information":[{"code":"3200268","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75809","type":"HCPCS"}],"standard_charges":[{"gross_charge":1211.0,"discounted_cash":726.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75820 VENOGRAM EXTREMITY UNILAT-LT","code_information":[{"code":"3200269","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1209.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 75820 VENOGRAM EXTREMITY UNILAT-RT","code_information":[{"code":"3200271","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1209.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 75822 VENOGRAM EXTREMITY BILAT","code_information":[{"code":"3200273","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1726.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75822 VENOGRAPHY BIL-LOWER EXTREM","code_information":[{"code":"3200274","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1726.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75822 VENOGRAM EXTREMITY BILAT (SURGICAL)","code_information":[{"code":"3200275","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2958.0,"discounted_cash":1774.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75825 VENOGRAM INFERIOR VENA CAVA","code_information":[{"code":"3200276","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":4889.0,"discounted_cash":2933.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75827 VENOGRAM SUPERIOR VENA CAVA","code_information":[{"code":"3200277","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":4461.0,"discounted_cash":2676.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75831 VENOGRAM RENAL UNILAT SELECTIVE-LT","code_information":[{"code":"3200278","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":4648.0,"discounted_cash":2788.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 75831 VENOGRAM RENAL UNILAT SELECTIVE-RT","code_information":[{"code":"3200279","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75831","type":"HCPCS"}],"standard_charges":[{"gross_charge":4648.0,"discounted_cash":2788.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 75833 VENOGRAM RENAL BILAT SELECTIVE","code_information":[{"code":"3200280","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75833","type":"HCPCS"}],"standard_charges":[{"gross_charge":6412.0,"discounted_cash":3847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75860 VENOGRAPHY, VENOUS SINUS S&I","code_information":[{"code":"3200283","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75860","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":1983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75870 VENOGRAPHY SUPERIOR SAGITTAL SINUS  S&I","code_information":[{"code":"3200284","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75870","type":"HCPCS"}],"standard_charges":[{"gross_charge":7700.0,"discounted_cash":4620.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75885 PORTOGRAPHY W/HEMODYNAMIC EVAL","code_information":[{"code":"3200285","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75885","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":1983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75887 PORTOGRAPHY W/O HEMODYNAMIC EVAL","code_information":[{"code":"3200286","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":1983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75889 HEPATIC VENOGR W/ HEMODYNAMIC EVAL","code_information":[{"code":"3200287","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6072.0,"discounted_cash":3643.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75891 HEPATIC VENO W/O HEMODYNAMIC EVAL","code_information":[{"code":"3200288","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75891","type":"HCPCS"}],"standard_charges":[{"gross_charge":5873.0,"discounted_cash":3523.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75893 VENOUS SAMPLE CATH W/ OR W/O ANGIOGRAM","code_information":[{"code":"3200289","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75893","type":"HCPCS"}],"standard_charges":[{"gross_charge":5676.0,"discounted_cash":3405.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75894 TRANSCATHETER THERAPEUTIC EMBOLIZATION","code_information":[{"code":"3200290","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75894","type":"HCPCS"}],"standard_charges":[{"gross_charge":8496.0,"discounted_cash":5097.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75898 ANGIOGRAM THRU EXISTING CATHETER F/U","code_information":[{"code":"3200292","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3305.0,"discounted_cash":1983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75970 TRANSCATHETER BIOPSY PROCEDURE","code_information":[{"code":"3200312","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75970","type":"HCPCS"}],"standard_charges":[{"gross_charge":6777.0,"discounted_cash":4066.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75984 CHANGE PERCUTANEOUS TUBE/DRAIN","code_information":[{"code":"3200316","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":499.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75989 PERC DRAIN ABSCESS W/PLACE CATH -XR","code_information":[{"code":"3200317","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76000 FLUOROSCOPY UP TO 1 HR","code_information":[{"code":"3200323","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76010 NOSE TO RECTUM, FB, 1 VIEW, CHILD","code_information":[{"code":"3200325","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":329.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76080 ABSCESS/FISTULA/SINUS TRACT STUDY","code_information":[{"code":"3200326","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.0,"discounted_cash":579.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76098 X-RAY SURGICAL SPECIMEN","code_information":[{"code":"3200327","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":690.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76098 X-RAY SURGICAL SPECIMEN, EA ADDL","code_information":[{"code":"3200328","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":690.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 76100 TOMOGRAM, SINGLE PLN (NON-URO) 1-5 CUT","code_information":[{"code":"3200329","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76100 TOMOGRAM, SINGLE PLN (NON-URO) 6-10 CUT","code_information":[{"code":"3200330","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.0,"discounted_cash":885.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76100 TOMOGRAM, SINGLE PLN (NON-URO) 11-15 CUT","code_information":[{"code":"3200331","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1871.0,"discounted_cash":1122.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76100 TOMOGRAM, SINGLE PLN (NON-URO) >15 CUT","code_information":[{"code":"3200332","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1292.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76496 UNLISTED FLUOROSCOPIC PROCEDURE","code_information":[{"code":"3200333","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76496","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77001 FLUORO GUIDANCE CVAD PLACEMENT CTH/COMPL","code_information":[{"code":"3200335","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1156.0,"discounted_cash":693.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77002 FLUORO, GUIDED NEEDLE PLACEMENT","code_information":[{"code":"3200336","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":729.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77003 FLUORO, LOCAL NEEDLE/CATHETER, SPINE","code_information":[{"code":"3200337","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1201.0,"discounted_cash":720.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77053 MAMMO DUCTOGRAM, SINGLE DUCT","code_information":[{"code":"3200343","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77053 MAMMO DUCTOGRAM, SINGLE DUCT-RED","code_information":[{"code":"3200344","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 77054 MAMMO DUCTOGRAM, MUTIPLE DUCTS","code_information":[{"code":"3200345","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.0,"discounted_cash":1114.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77071 STRESS VIEW(S), INCLD CONTRALATERAL JNT","code_information":[{"code":"3200346","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77072 BONE AGE, STUDIES-I","code_information":[{"code":"3200347","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77072 BONE AGE,  STUDIES-II","code_information":[{"code":"3200348","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77073 BONE LENGTH, STUDIES","code_information":[{"code":"3200349","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":497.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77074 OSSEOUS SURVEY, LIMITED","code_information":[{"code":"3200350","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1123.0,"discounted_cash":673.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77075 OSSEOUS SURVEY, COMPLETE","code_information":[{"code":"3200351","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1847.0,"discounted_cash":1108.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77076 OSSEOUS SURVEY, INFANT","code_information":[{"code":"3200352","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":341.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77077 JOINT SURVEY, 1 VIEW, 2 OR  MORE JNTS","code_information":[{"code":"3200353","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77077","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77080 DEXA SC, 1 OR MORE SITES, AXIAL SKELETON","code_information":[{"code":"3200354","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"discounted_cash":576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0278 ILIAC/FEMORAL ARTERY ANGIO W/CATH","code_information":[{"code":"3200364","type":"CDM"},{"code":"0320","type":"RC"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":3771.0,"discounted_cash":2262.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74445 CORPORA CAVERNOSOGRAPHY","code_information":[{"code":"3200366","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74445","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.0,"discounted_cash":557.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74470 RENAL CYST STUDY TRANSLUMBAR","code_information":[{"code":"3200367","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.0,"discounted_cash":1331.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70140 FACIAL BONES < 3V","code_information":[{"code":"3200368","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77081 BC-DEXA,1 OR MORE SITES,APNDIC SKELETON","code_information":[{"code":"3200372","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":484.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74190 PERITONEGRAM-RAD S&I","code_information":[{"code":"3200373","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1929.0,"discounted_cash":1157.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76377 3D RECONTRUCT W/ PP ON INDEP WORKSTATION","code_information":[{"code":"3200376","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":436.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36221 NON-SLCT CATH PLACE THOR AORTA W/ANGIO CC ARCH","code_information":[{"code":"3200378","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36221","type":"HCPCS"}],"standard_charges":[{"gross_charge":12115.0,"discounted_cash":7269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36222 SLCT CATH PLACE COMM CARTD ART W/ANGIO CC ARCH-RT","code_information":[{"code":"3200379","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":13170.0,"discounted_cash":7902.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36222 SLCT CATH PLACE COMM CARTD ART W/ANGIO CC ARCH-LT","code_information":[{"code":"3200380","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":13170.0,"discounted_cash":7902.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36222 SLCT CATH PLACE COMM CARTD ART W/ANGIO CC ARCH-BLT","code_information":[{"code":"3200381","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":19754.0,"discounted_cash":11852.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36223 SLCT CATH PLACE COMM CARTD ART W/ANGIO EC CARTD-RT","code_information":[{"code":"3200382","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":19759.0,"discounted_cash":11855.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36223 SLCT CATH PLACE COMM CARTD ART W/ANGIO EC CARTD-LT","code_information":[{"code":"3200383","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":19759.0,"discounted_cash":11855.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36223 SLCT CATH PLACE COMM CARTD ART W/ANGIO EC CARTD-BLT","code_information":[{"code":"3200384","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":29638.0,"discounted_cash":17782.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36224 SLCT CATH PLACE INTNL CARTD ART W/ANGIO EC CARTD-RT","code_information":[{"code":"3200385","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":32311.0,"discounted_cash":19386.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36224 SLCT CATH PLACE INTNL CARTD ART W/ANGIO EC CARTD-LT","code_information":[{"code":"3200386","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":32311.0,"discounted_cash":19386.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36224 SLCT CATH PLACE INTNL CARTD ART W/ANGIO EC CARTD-BLT","code_information":[{"code":"3200387","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":48465.0,"discounted_cash":29079.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36225 SLCT CATH PLACE SUBCLV ART W/ANGIO CC ARCH-RT","code_information":[{"code":"3200388","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":19759.0,"discounted_cash":11855.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36225 SLCT CATH PLACE SUBCLV ART W/ANGIO CC ARCH-LT","code_information":[{"code":"3200389","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":19759.0,"discounted_cash":11855.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36225 SLCT CATH PLACE SUBCLV ART W/ANGIO CC ARCH-BLT","code_information":[{"code":"3200390","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":29638.0,"discounted_cash":17782.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36226 SLCT CATH PLACE VERT ART W/ANGIO CC ARCH-RT","code_information":[{"code":"3200391","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":32311.0,"discounted_cash":19386.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36226 SLCT CATH PLACE VERT ART W/ANGIO CC ARCH-LT","code_information":[{"code":"3200392","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":32311.0,"discounted_cash":19386.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36226 SLCT CATH PLACE VERT ART W/ANGIO CC ARCH-BLT","code_information":[{"code":"3200393","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":48465.0,"discounted_cash":29079.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36228 SLCT CATH PLACE EA INTRACRANL BRANCH INTL CAROTD/VERT ART-RT","code_information":[{"code":"3200394","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":15456.0,"discounted_cash":9273.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36228 SLCT CATH PLACE EA INTRACRANL BRANCH INTL CAROTD/VERT ART-LT","code_information":[{"code":"3200395","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":15456.0,"discounted_cash":9273.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36228 SLCT CATH PLACE EA INTRACRANL BRANCH INTL CAROTD/VERT ART-BLT","code_information":[{"code":"3200396","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":23191.0,"discounted_cash":13914.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36227 SLCT CATH PLC EXT CARTD ART W/ANGIO IPSILAT EX CARTD-RT","code_information":[{"code":"3200397","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":12369.0,"discounted_cash":7421.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36227 SLCT CATH PLC EXT CARTD ART W/ANGIO IPSILAT EX CARTD-LT","code_information":[{"code":"3200398","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":12369.0,"discounted_cash":7421.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36227 SLCT CATH PLC EXT CARTD ART W/ANGIO IPSILAT EX CARTD-BLT","code_information":[{"code":"3200399","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":18547.0,"discounted_cash":11128.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 49405 FLUORO-GUIDED DRAINAGE VISCERAL","code_information":[{"code":"3200422","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3428.0,"discounted_cash":2056.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49406 FLUORO-GUIDED DRN PERITONEAL/RETROPERITONEAL","code_information":[{"code":"3200423","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3231.0,"discounted_cash":1938.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49407 FLUORO GUIDED DRN PERITONEAL/RETRO TR/TV","code_information":[{"code":"3200424","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49407","type":"HCPCS"}],"standard_charges":[{"gross_charge":5127.0,"discounted_cash":3076.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10030 FLUORO GUIDED DRAINAGE SOFT TISSUE PERC","code_information":[{"code":"3200425","type":"CDM"},{"code":"0320","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2098.0,"discounted_cash":1258.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCATH VERT STENT-OPEN OR PERC-INITIAL","code_information":[{"code":"3200436","type":"CDM"},{"code":"0323","type":"RC"},{"code":"0075T","type":"HCPCS"}],"standard_charges":[{"gross_charge":23080.0,"discounted_cash":13848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCATH VERT STENT-OPEN OR PERC- EA ADDL","code_information":[{"code":"3200437","type":"CDM"},{"code":"0323","type":"RC"},{"code":"0076T","type":"HCPCS"}],"standard_charges":[{"gross_charge":11549.0,"discounted_cash":6929.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72081 XRAY ENTIRE SPINE 1 VIEW","code_information":[{"code":"3200441","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":306.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72082 XRAY ENTIRE SPINE 2/3 VIEW","code_information":[{"code":"3200442","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":591.0,"discounted_cash":354.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72083 XRAY ENTIRE SPINE 4/5 VIEW","code_information":[{"code":"3200443","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72084 XRAY ENTIRE SPINE MIN 6 VIEW","code_information":[{"code":"3200444","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":755.0,"discounted_cash":453.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 72080 XRAY THORACOLUMBAR JUNCT (MIN 2V)","code_information":[{"code":"3200445","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73501 HIP 1 VIEW (W PELVIS) -RT","code_information":[{"code":"3200446","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":333.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73501 HIP 1 VIEW (W PELVIS) -LT","code_information":[{"code":"3200447","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":333.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73502 HIP 2/3 VIEW (W PELVIS) -RT","code_information":[{"code":"3200448","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":424.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73502 HIP 2/3 VIEW (W PELVIS) - LT","code_information":[{"code":"3200449","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":424.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73503 HIP MIN 4 VIEW (W PELVIS) - RT","code_information":[{"code":"3200450","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73503 HIP MIN 4 VIEW (W PELVIS) - LT","code_information":[{"code":"3200451","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73521 HIP 2 VIEW (W PELVIS) - BIL","code_information":[{"code":"3200452","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73522 HIP 3/4 VIEW (W PELVIS) - BIL","code_information":[{"code":"3200453","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.0,"discounted_cash":556.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73523 HIP MIN 5 VIEW (W PELVIS) - BIL","code_information":[{"code":"3200454","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":710.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 73551 FEMUR 1 VIEW - RT","code_information":[{"code":"3200455","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":698.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73551 FEMUR 1 VIEW - LT","code_information":[{"code":"3200456","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":698.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73552 FEMUR MIN 2 VIEW - RT","code_information":[{"code":"3200457","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":658.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73552 FEMUR MIN 2 VIEW - LT","code_information":[{"code":"3200458","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":658.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73551 FEMUR 1 VIEW - BIL","code_information":[{"code":"3200459","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":1043.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73552 FEMUR MIN 2 VIEW - BLT","code_information":[{"code":"3200460","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":985.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 71045 CHEST SINGLE VIEW","code_information":[{"code":"3200464","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":279.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71046 CHEST 2 VIEWS","code_information":[{"code":"3200465","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":328.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71047 CHEST 3 VIEWS","code_information":[{"code":"3200466","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":391.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71048 CHEST 4 OR MORE VIEWS","code_information":[{"code":"3200467","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":441.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74018 ABDOMEN SINGLE VIEW","code_information":[{"code":"3200468","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":544.0,"discounted_cash":326.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74019 ABDOMEN 2 VIEWS","code_information":[{"code":"3200469","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":663.0,"discounted_cash":397.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74021 ABDOMEN 3 OR MORE VIEWS","code_information":[{"code":"3200470","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71045 CHEST SINGLE VIEW (EH)","code_information":[{"code":"3200471","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71045 CHEST SINGLE VIEW PORTABLE","code_information":[{"code":"3200472","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":279.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71046 CHEST PA & LAT (EH)","code_information":[{"code":"3200473","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":334.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71048 CHEST 2V W/ OBLIQUES","code_information":[{"code":"3200474","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.0,"discounted_cash":441.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 71048 CHEST-2 VIEWS W/FLUORO","code_information":[{"code":"3200475","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.0,"discounted_cash":538.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10007 FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION","code_information":[{"code":"3200476","type":"CDM"},{"code":"0320","type":"RC"},{"code":"10007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2174.0,"discounted_cash":1304.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10008 FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL","code_information":[{"code":"3200477","type":"CDM"},{"code":"0320","type":"RC"},{"code":"10008","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27369 INJ PROC CNTRST KNEE ARTHRGRPHY/CNTRST ENHNCD CT/MRI KNEE ARTHG-LT","code_information":[{"code":"3200478","type":"CDM"},{"code":"0320","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":995.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27369 INJ PROC CNTRST KNEE ARTHRGRPHY/CNTRST ENHNCD CT/MRI KNEE ARTHG-RT","code_information":[{"code":"3200479","type":"CDM"},{"code":"0320","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":995.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50436 PERQ DILATION XST TRC ENDOUROLOGIC PROC W/IMG-RT","code_information":[{"code":"3200480","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":5510.0,"discounted_cash":3306.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50436 PERQ DILATION XST TRC ENDOUROLOGIC PROC W/IMG-BLT","code_information":[{"code":"3200481","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":5978.0,"discounted_cash":3586.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50437 PERQ DILATION XST TRC NEW ACCESS RENAL COLL SYS W/IMG-LT","code_information":[{"code":"3200482","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50437","type":"HCPCS"}],"standard_charges":[{"gross_charge":5510.0,"discounted_cash":3306.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50437 PERQ DILATION XST TRC NEW ACCESS RENAL COLL SYS W/IMG-RT","code_information":[{"code":"3200483","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50437","type":"HCPCS"}],"standard_charges":[{"gross_charge":5510.0,"discounted_cash":3306.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50437 PERQ DILATION XST TRC NEW ACCESS RENAL COLL SYS W/IMG-BLT","code_information":[{"code":"3200484","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50437","type":"HCPCS"}],"standard_charges":[{"gross_charge":5978.0,"discounted_cash":3586.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 74485 DILATION, URETERS/URETHRA","code_information":[{"code":"3200485","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74485","type":"HCPCS"}],"standard_charges":[{"gross_charge":7323.0,"discounted_cash":4393.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 50436 PERQ DILATION XST TRC ENDOUROLOGIC PROC W/IMG-LT","code_information":[{"code":"3200486","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50436","type":"HCPCS"}],"standard_charges":[{"gross_charge":5510.0,"discounted_cash":3306.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73140 FINGER(S) MIN 2 VIEWS RT","code_information":[{"code":"3200487","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73140 FINGER(S) MIN 2 VIEWS LT","code_information":[{"code":"3200488","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73140 FINGER(S) MIN 2 VIEWS BLT","code_information":[{"code":"3200489","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":460.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73660 TOE(S) MIN  2V RT","code_information":[{"code":"3200490","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":268.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73660 TOE(S) MIN  2V LT","code_information":[{"code":"3200491","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":268.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 73660 TOE(S) MIN  2V BLT","code_information":[{"code":"3200492","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":452.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 74240 RADIOLOGIC EXAM UPPER GI TRACT SINGLE CONTRAST STUDY","code_information":[{"code":"3200505","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":883.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74246 RADIOLOGIC EXAM UPPER GI TRACT DOUBLE CONTRAST STUDY","code_information":[{"code":"3200506","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1831.0,"discounted_cash":1098.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74248 RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY","code_information":[{"code":"3200507","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74221 RADIOLOGIC EXAM OF ESOPHAGUS DOUBLE CONTRAST STUDY","code_information":[{"code":"3200508","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.0,"discounted_cash":917.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 74425 UROGRAM ANTEGRADE W/SUPRV AND INTERP","code_information":[{"code":"3200524","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1478.0,"discounted_cash":886.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLC INTERSTITIAL RAD THRPY BREAST-DELAY","code_information":[{"code":"3330001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"19296","type":"HCPCS"}],"standard_charges":[{"gross_charge":17903.0,"discounted_cash":10741.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLC INTERSTITIAL RADTHERAPY BREAST IMMED","code_information":[{"code":"3330002","type":"CDM"},{"code":"0333","type":"RC"},{"code":"19297","type":"HCPCS"}],"standard_charges":[{"gross_charge":15150.0,"discounted_cash":9090.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77280 RDT SIMPLE SIMULATION-FAC","code_information":[{"code":"3330004","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.0,"discounted_cash":1062.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77285 RDT INTERMEDIATE SIMULATION-FAC","code_information":[{"code":"3330005","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2032.0,"discounted_cash":1219.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77290 RDT COMPLEX SIMULATION-FAC","code_information":[{"code":"3330006","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2679.0,"discounted_cash":1607.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77295 RDT 3-D THERAPY PLAN INC DOSE VOL HISTOGRAMS","code_information":[{"code":"3330007","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":10176.0,"discounted_cash":6105.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77300 RDT BASIC DOSIMETRY CALC-FAC","code_information":[{"code":"3330008","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77301 IMRT TREATMENT PLANNING","code_information":[{"code":"3330009","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":10785.0,"discounted_cash":6471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77321 RDT SPECIAL PORT PLAN TOTAL BODY","code_information":[{"code":"3330013","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.0,"discounted_cash":3606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77331 RDT SPECIAL DOSIMETRY-FAC","code_information":[{"code":"3330017","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":789.0,"discounted_cash":473.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77332 RDT TREATMENT DEVICE SIMPLE-FAC","code_information":[{"code":"3330018","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77333 RDT TREATMENT DEVICE INTERMED-FAC","code_information":[{"code":"3330019","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.0,"discounted_cash":704.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77334 RDT TREATMENT DEVICE COMPLEX-FAC","code_information":[{"code":"3330020","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1784.0,"discounted_cash":1070.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77336 RADIATION PHYSICS CONSULT-FAC","code_information":[{"code":"3330021","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":1659.0,"discounted_cash":995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77370 SPECIAL MED RAD PHYSICS CONSULT-FAC","code_information":[{"code":"3330022","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1786.0,"discounted_cash":1071.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77371 STER RADSURG GAMMA CRANIAL ONE SESSION","code_information":[{"code":"3330023","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77371","type":"HCPCS"}],"standard_charges":[{"gross_charge":66906.0,"discounted_cash":40143.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77372 STER RADSURG,LINAC CRANIAL,ONE SESSION","code_information":[{"code":"3330024","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77372","type":"HCPCS"}],"standard_charges":[{"gross_charge":32210.0,"discounted_cash":19326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77373 STER RADSURG,LINEAR,BODY,PER SESSION,2ND-5TH SESSION","code_information":[{"code":"3330028","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":10737.0,"discounted_cash":6442.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77373 STEREOTACTIC BODY RADIATION TREATMENT DELIVERY","code_information":[{"code":"3330029","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":18478.0,"discounted_cash":11086.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77417 RDT THERAPEUTIC PORT FILM(S)","code_information":[{"code":"3330039","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":500.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77470 RDT SPECIAL TREATMENT PROC-FAC","code_information":[{"code":"3330042","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4589.0,"discounted_cash":2753.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77750 RDT INFUSE/INST RADIOELMNT SOL-FAC","code_information":[{"code":"3330043","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77750","type":"HCPCS"}],"standard_charges":[{"gross_charge":4370.0,"discounted_cash":2622.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77761 INTRACAVITARY RAD SOURC APPL, SIMPLE-FAC","code_information":[{"code":"3330044","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":2756.0,"discounted_cash":1653.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77762 INTRACAVITARY RAD SOURC APPL, INTERM-FAC","code_information":[{"code":"3330045","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":4119.0,"discounted_cash":2471.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77763 INTRACAVITARY RAD SOURC APPL, COMPLX-FAC","code_information":[{"code":"3330046","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":5926.0,"discounted_cash":3555.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77790 SUPERVISION, LOADING RAD SOURCE-FAC","code_information":[{"code":"3330054","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77790","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":497.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96401 CHEMO,SQ/IM;NON-HORM ANTI-NEO","code_information":[{"code":"3330055","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96402 CHEMO,SQ OR IM;HORM ANTI-NEO","code_information":[{"code":"3330056","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96409 CHEMO;IVP SNGLE/INIT SUB/DRUG","code_information":[{"code":"3330057","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96411 CHEMO;IVP EA ADD SUB/DRUG","code_information":[{"code":"3330058","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":452.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96413 CHEMO;IV INF;SNGL/INITL UP TO 1HR","code_information":[{"code":"3330059","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1917.0,"discounted_cash":1150.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96415 CHEMO;IV INF;EA ADD HR","code_information":[{"code":"3330060","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.0,"discounted_cash":575.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96416 / G0498 CHEMO ADMIN, EXTENDED IV INF, WITH PORTABLE PUMP","code_information":[{"code":"3330061","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96416","type":"HCPCS"}],"standard_charges":[{"gross_charge":2349.0,"discounted_cash":1409.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96417 CHEMO;IV INF;EA,ADD'L SEQ DRUG 0-1 HR","code_information":[{"code":"3330062","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":1917.0,"discounted_cash":1150.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96420 CHEMO;INTRA-ARTERIAL, PUSH TECH","code_information":[{"code":"3330063","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96420","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":487.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96440 CHEMO,PLEUR CAV,RQ/INC CENTESIS","code_information":[{"code":"3330064","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1675.0,"discounted_cash":1005.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96542 CHEMO;SA/IV VIA SUBCUT RESVOIR","code_information":[{"code":"3330066","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96542","type":"HCPCS"}],"standard_charges":[{"gross_charge":2734.0,"discounted_cash":1640.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACHYTHER NON-STRAND IRIDIUM 192 SOURCE","code_information":[{"code":"3330072","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1717","type":"HCPCS"}],"standard_charges":[{"gross_charge":1816.0,"discounted_cash":1089.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77338 MLC FOR IMRT,DESIGN & CONSTR/IMRT PLN","code_information":[{"code":"3330074","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":3019.0,"discounted_cash":1811.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96446 CHEMO ADMIN BY PERITONEAL CATH OR PORT","code_information":[{"code":"3330075","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96446","type":"HCPCS"}],"standard_charges":[{"gross_charge":2734.0,"discounted_cash":1640.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96450 CHEMOTHERAPY ADMIN INTO CNS","code_information":[{"code":"3330076","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2088.0,"discounted_cash":1252.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RDT BASIC DOSIMETRY CALC EA ADDTL FAC","code_information":[{"code":"3330082","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":604.8,"setting":"both","modifier_code":["76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC 51720 TREATMENT OF BLADDER LESION","code_information":[{"code":"3330083","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51720","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":402.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RDT TREATMENT DEVICE COMPLEX EA ADDTL FAC","code_information":[{"code":"3330084","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1784.0,"discounted_cash":1070.4,"setting":"both","modifier_code":["76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC 77293 RESPIRATORY MOTION MGMT SIMULATION ADD ON CODE","code_information":[{"code":"3330088","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":3560.0,"discounted_cash":2136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77306 TELETHERAPY ISODOSE PLAN; SIMPLE, INC BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"3330089","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.0,"discounted_cash":3606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77307 TELETHERAPY ISODOSE PLAN; COMPLEX, INC BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"3330090","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.0,"discounted_cash":3606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACHYTHERAPY ISODOSE PLAN; SIMPLE W BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"3330091","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.0,"discounted_cash":3606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACHYTHERAPY ISODOSE PLAN; INTERMEDIATE W BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"3330092","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.0,"discounted_cash":3606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRACHYTHERAPY ISODOSE PLAN; COMPLEX W BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"3330093","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":6426.0,"discounted_cash":3855.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77402 RADIATION TREATMENT DELIVERY LEVEL 1","code_information":[{"code":"3330094","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1254.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77407 RADIATION TREATMENT DELIVERY LEVEL 2","code_information":[{"code":"3330095","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":7904.0,"discounted_cash":4742.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77412 RADIATION TREATMENT DELIVERY LEVEL 3","code_information":[{"code":"3330096","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":8471.0,"discounted_cash":5082.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77387 GUIDANCE FOR LOC OF TARGET VOLUME, INC INTRAFRACTION TRACKING, WHEN PERFORMED","code_information":[{"code":"3330097","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77387","type":"HCPCS"}],"standard_charges":[{"gross_charge":2202.0,"discounted_cash":1321.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77332 RDT TREATMENT DEVICE SIMPLE-EA ADDTL FAC","code_information":[{"code":"3330100","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC 77333 RDT TREATMENT DEVICE INTERMED-EA ADDTL FAC","code_information":[{"code":"3330101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":1174.0,"discounted_cash":704.4,"setting":"both","modifier_code":["76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC 77280 RDT SIMPLE SIMULATION-SECOND DAILY SIM-FAC","code_information":[{"code":"3330102","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.0,"discounted_cash":1062.6,"setting":"both","modifier_code":["76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC UNLISTED PROC 250AL BRACHYTHERAPY SIMPLE FAC","code_information":[{"code":"3330106","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77799","type":"HCPCS"}],"standard_charges":[{"gross_charge":3282.0,"discounted_cash":1969.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HDR INTRSTL/INTRCVTY + BASIC DOSMTRY 1 CHNL","code_information":[{"code":"3330108","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77770","type":"HCPCS"}],"standard_charges":[{"gross_charge":5329.0,"discounted_cash":3197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HDR INTRSTL/INTRCVTY + BASIC DOSMTRY 2-12 CHNL","code_information":[{"code":"3330109","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77771","type":"HCPCS"}],"standard_charges":[{"gross_charge":8633.0,"discounted_cash":5179.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROC 250AL BRACHYTHERAPY INTRMD FAC","code_information":[{"code":"3330112","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77799","type":"HCPCS"}],"standard_charges":[{"gross_charge":5144.0,"discounted_cash":3086.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REM AFTERLOAD HDR OR BRACHY INC DOS;2.0 CM OR 1 CH-FAC","code_information":[{"code":"3330113","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77767","type":"HCPCS"}],"standard_charges":[{"gross_charge":6337.0,"discounted_cash":3802.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REM AFTRLD HDR OR BRACHY INC DOS;2.0 CM OR 2-12 CH-FAC","code_information":[{"code":"3330114","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8428.0,"discounted_cash":5056.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RO RADIOPHARMACEUTICAL TX IV ADMIN","code_information":[{"code":"3330115","type":"CDM"},{"code":"0333","type":"RC"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.0,"discounted_cash":753.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96405 CHEMO ADMIN; INTRALESIONAL UP TO 7 LSNS - FAC","code_information":[{"code":"3330116","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96405","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":474.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96406 CHEMO ADMIN; INTRALESIONAL OVER 7 LSNS - FAC","code_information":[{"code":"3330117","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1169.0,"discounted_cash":701.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0498 CHEMOTHERAPY ADMINISTRATION, EXTENDED IV INFUSION, WITH PORTABLE PUMP","code_information":[{"code":"3330118","type":"CDM"},{"code":"0335","type":"RC"},{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":883.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM THYROID CA METASTASES, LIMITED","code_information":[{"code":"3400006","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78015","type":"HCPCS"}],"standard_charges":[{"gross_charge":2040.0,"discounted_cash":1224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM THYROID CA METASTASES, WHOLE BODY","code_information":[{"code":"3400007","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":3772.0,"discounted_cash":2263.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM THYROID CA METASTASES UPTAKE","code_information":[{"code":"3400008","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.0,"discounted_cash":692.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM PARATHYROID IMAGING","code_information":[{"code":"3400009","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2636.0,"discounted_cash":1581.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM BONE MARROW IMAGING-WHOLE BODY","code_information":[{"code":"3400010","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78104","type":"HCPCS"}],"standard_charges":[{"gross_charge":2653.0,"discounted_cash":1591.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM WHOLE BLOOD VOLUME DETERMN","code_information":[{"code":"3400011","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78122","type":"HCPCS"}],"standard_charges":[{"gross_charge":3034.0,"discounted_cash":1820.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM LYPHATIC/NODES IMAGING","code_information":[{"code":"3400012","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":2877.0,"discounted_cash":1726.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM LIVER & SPLEEN IMAGING, STATIC","code_information":[{"code":"3400015","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2915.0,"discounted_cash":1749.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM SALIVARY GLAND W/ SERIAL IMAGES","code_information":[{"code":"3400018","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78231","type":"HCPCS"}],"standard_charges":[{"gross_charge":2081.0,"discounted_cash":1248.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM SALIVARY GLAND FUNCTION STUDY","code_information":[{"code":"3400019","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1951.0,"discounted_cash":1170.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM ESOPHAGEAL MOTILITY","code_information":[{"code":"3400020","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78258","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":778.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM GASTROESOPHAGEAL REFLUX STUDY","code_information":[{"code":"3400021","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78262","type":"HCPCS"}],"standard_charges":[{"gross_charge":2583.0,"discounted_cash":1549.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM GI BLOOD LOSS IMAGING","code_information":[{"code":"3400023","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2977.0,"discounted_cash":1786.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM INTESTINE IMAGING (MECKELS)","code_information":[{"code":"3400024","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":4464.0,"discounted_cash":2678.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM PV SHUNT PATENCY TEST","code_information":[{"code":"3400025","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78291","type":"HCPCS"}],"standard_charges":[{"gross_charge":2706.0,"discounted_cash":1623.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM UNLISTED GI PROCEDURE","code_information":[{"code":"3400026","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":868.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM BONE/JOINT IMAGING, LIMITED AREA","code_information":[{"code":"3400027","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2319.0,"discounted_cash":1391.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM BONE/JOINT IMAGING,MULTIPLE AREA","code_information":[{"code":"3400028","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2573.0,"discounted_cash":1543.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM BONE/JOINT IMAGING, WHOLE BODY","code_information":[{"code":"3400029","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3368.0,"discounted_cash":2020.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM BONE/JOINT IMAGING,3 PHASE STUDY","code_information":[{"code":"3400030","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3790.0,"discounted_cash":2274.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM CARDIAC SHUNT DETECTION","code_information":[{"code":"3400032","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78428","type":"HCPCS"}],"standard_charges":[{"gross_charge":2369.0,"discounted_cash":1421.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM NON-CARDIAC VASCULAR FLOW IMAGING","code_information":[{"code":"3400033","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":868.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MYOCARDIAL, PET, METABOLIC EVAL","code_information":[{"code":"3400034","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78459","type":"HCPCS"}],"standard_charges":[{"gross_charge":10734.0,"discounted_cash":6440.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MUGA SINGLE STUDY, SINGLE","code_information":[{"code":"3400037","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":3512.0,"discounted_cash":2107.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MUGA, MULTIPLE STUDIES","code_information":[{"code":"3400038","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78473","type":"HCPCS"}],"standard_charges":[{"gross_charge":4452.0,"discounted_cash":2671.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM PULMONARY PERFUSION, PARTICULATE","code_information":[{"code":"3400041","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2744.0,"discounted_cash":1646.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM UNLISTED RESPIRATORY PROCED","code_information":[{"code":"3400047","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78599","type":"HCPCS"}],"standard_charges":[{"gross_charge":1495.0,"discounted_cash":897.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM BRAIN IMAGING,MIN 4 VIEW W/ VASC FLOW","code_information":[{"code":"3400048","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78606","type":"HCPCS"}],"standard_charges":[{"gross_charge":3282.0,"discounted_cash":1969.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM CISTERNOGRAPHY","code_information":[{"code":"3400050","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78630","type":"HCPCS"}],"standard_charges":[{"gross_charge":3594.0,"discounted_cash":2156.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM CSF IMAGING SHUNT EVAL","code_information":[{"code":"3400051","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2518.0,"discounted_cash":1510.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM CSF LEAKAGE DETECTION & LOCALIZATION","code_information":[{"code":"3400053","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78650","type":"HCPCS"}],"standard_charges":[{"gross_charge":3143.0,"discounted_cash":1885.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM DACRYOCYSTOGRAPHY","code_information":[{"code":"3400054","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78660","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.0,"discounted_cash":906.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM KIDNEY IMAGING STATIC ONLY","code_information":[{"code":"3400055","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2401.0,"discounted_cash":1440.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM KIDNEY IMAGING W/ VASCULAR FLOW","code_information":[{"code":"3400056","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM KIDNEY, W/ VASC FLOW, SINGLE W/O PHAR","code_information":[{"code":"3400057","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":3249.0,"discounted_cash":1949.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM KIDNEY, W/ VASC FLOW, SINGLE W/ PHAR","code_information":[{"code":"3400058","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":3325.0,"discounted_cash":1995.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM KIDNEY, W/ VASC FLOW, MULT, WO/W PHAR","code_information":[{"code":"3400059","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78709","type":"HCPCS"}],"standard_charges":[{"gross_charge":2996.0,"discounted_cash":1797.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM URINARY BLADDER RESID STUDY","code_information":[{"code":"3400061","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78730","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":452.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM URETERAL REFLUX STUDY","code_information":[{"code":"3400062","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78740","type":"HCPCS"}],"standard_charges":[{"gross_charge":2451.0,"discounted_cash":1470.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM TESTICULAR IMAGING W/ VASCULAR FLOW","code_information":[{"code":"3400063","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1514.0,"discounted_cash":908.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 79005 NM RADIOPHARMACEUTICAL ADMIN  ORAL","code_information":[{"code":"3400076","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2898.0,"discounted_cash":1738.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM RADIOPHARMACEUTICAL TX IV ADMIN","code_information":[{"code":"3400078","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM RADIOPHARMACEUTICAL TX INTRA-CAVITARY","code_information":[{"code":"3400079","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1367.0,"discounted_cash":820.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM THERAPY,RADIO-LABELED IV INFUSION","code_information":[{"code":"3400080","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79403","type":"HCPCS"}],"standard_charges":[{"gross_charge":3903.0,"discounted_cash":2341.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM ACUTE VENOUS THROMOSIS, PEPTIDE","code_information":[{"code":"3400085","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78456","type":"HCPCS"}],"standard_charges":[{"gross_charge":2869.0,"discounted_cash":1721.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MYOCARD IMAGING, INFARCT AVID, PLANAR","code_information":[{"code":"3400088","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78466","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM CARDIAC BLOOD POOL, 1ST PASS, SINGLE","code_information":[{"code":"3400089","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.0,"discounted_cash":917.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM CARDIAC BLOOD POOL, 1ST PASS, MULTIPL","code_information":[{"code":"3400090","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3605.0,"discounted_cash":2163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM BRAIN IMAGING, VASCULAR FLOW ONLY","code_information":[{"code":"3400091","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78610","type":"HCPCS"}],"standard_charges":[{"gross_charge":2025.0,"discounted_cash":1215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MYOCARDIAL PERFUS,SPECT,SNG REST/EXCE","code_information":[{"code":"3400092","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":4774.0,"discounted_cash":2864.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MYOCARDIAL PERFUS,SPECT,MLTP STDY R/E","code_information":[{"code":"3400093","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":7779.0,"discounted_cash":4667.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MYOCARDIAL PERFUS, PLANAR SNGL","code_information":[{"code":"3400094","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78453","type":"HCPCS"}],"standard_charges":[{"gross_charge":4774.0,"discounted_cash":2864.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM MYOCARDIAL PERFUS, PLANAR MLTPLE","code_information":[{"code":"3400095","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78454","type":"HCPCS"}],"standard_charges":[{"gross_charge":5594.0,"discounted_cash":3356.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM HEPATOBILIARY SYST IMAG INC GALLBLADDER","code_information":[{"code":"3400096","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":3359.0,"discounted_cash":2015.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM HEPATOBILIARY SYST IMAG INC GB WITH PHARMA INTV","code_information":[{"code":"3400097","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":3697.0,"discounted_cash":2218.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM PULMONARY VENT IMAGING","code_information":[{"code":"3400098","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78579","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM PULM VENT AND PERFUSION IMAGING","code_information":[{"code":"3400099","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":3889.0,"discounted_cash":2333.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM QUANT DIFF PULM PERFUSION INC IMAG","code_information":[{"code":"3400100","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78597","type":"HCPCS"}],"standard_charges":[{"gross_charge":3842.0,"discounted_cash":2305.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM QUANT DIFF PULM PERFUS AND VENT INC IMAG","code_information":[{"code":"3400101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":3977.0,"discounted_cash":2386.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM THYROID UPTAKE SNGL OR MULT MEASUREMENTS","code_information":[{"code":"3400102","type":"CDM"},{"code":"0340","type":"RC"},{"code":"78012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.0,"discounted_cash":774.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM THYROID IMAGING INC VASC FLOW IF PERFORMED","code_information":[{"code":"3400103","type":"CDM"},{"code":"0340","type":"RC"},{"code":"78013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1758.0,"discounted_cash":1054.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM THYROID IMAGING INC VASC FLOW W/ SINGL OR MULT UPTAKE MEASURMNTS","code_information":[{"code":"3400104","type":"CDM"},{"code":"0340","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":2473.0,"discounted_cash":1483.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM PARATHYROID PLANAR IMAGING W/ SPECT","code_information":[{"code":"3400105","type":"CDM"},{"code":"0340","type":"RC"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":3270.0,"discounted_cash":1962.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM PARATHYROID PLANAR W/SPECT&CT","code_information":[{"code":"3400106","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78072","type":"HCPCS"}],"standard_charges":[{"gross_charge":4029.0,"discounted_cash":2417.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM GASTRIC EMPTYING STUDY","code_information":[{"code":"3400111","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2865.0,"discounted_cash":1719.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NM GASTRIC EMPTYING STUDY/ SB","code_information":[{"code":"3400112","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78265","type":"HCPCS"}],"standard_charges":[{"gross_charge":985.0,"discounted_cash":591.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78800 NM LOCALIZATION TUMOR/PLANAR 1 AREA I DAY IMAGING","code_information":[{"code":"3400117","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2408.0,"discounted_cash":1444.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78801 NM LOCALIZATION TUMOR/PLANAR 2 AREA 1 DAY OR 1 AREA 2 DAY IMAGING","code_information":[{"code":"3400118","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78801","type":"HCPCS"}],"standard_charges":[{"gross_charge":3237.0,"discounted_cash":1942.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78802 NM LOCALIZATION TUMOR/WHOLE BODY PLANAR 1 DAY IMAGING","code_information":[{"code":"3400119","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":4025.0,"discounted_cash":2415.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78803 NM LOCALIZATOIN TUMOR/SPECT 1 AREA 1 DAY IMAGING","code_information":[{"code":"3400120","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":4018.0,"discounted_cash":2410.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78804 NM LOCALIZATION TUMOR/WHOLE BODY PLANAR 2 DAY IMAGING","code_information":[{"code":"3400121","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78804","type":"HCPCS"}],"standard_charges":[{"gross_charge":4857.0,"discounted_cash":2914.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78830 NM LOCALIZATION TUMOR/SPECT W/CT 1 AREA 1 DAY IMAGING","code_information":[{"code":"3400122","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78830","type":"HCPCS"}],"standard_charges":[{"gross_charge":5358.0,"discounted_cash":3214.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78831 NM LOCALIZATION TUMOR/SPECT 2 AREA 1 DAY/1 AREA 2 DAY IMAGING","code_information":[{"code":"3400123","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78831","type":"HCPCS"}],"standard_charges":[{"gross_charge":6029.0,"discounted_cash":3617.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78832 NM LOCALIZATION TUMOR/SPECT W/CT 2 AREA 1 DAY/1 AREA 2 DAY IMAGING","code_information":[{"code":"3400124","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78832","type":"HCPCS"}],"standard_charges":[{"gross_charge":8036.0,"discounted_cash":4821.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78429 NM MYOCRD IMAGING PET METAB EVAL SINGLE STUDY W/CT","code_information":[{"code":"3400125","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78429","type":"HCPCS"}],"standard_charges":[{"gross_charge":6738.0,"discounted_cash":4042.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78430 NM MYOCRD IMAGING PET PERFUSION REST OR STRESS SINGLE STUDY W/CT","code_information":[{"code":"3400126","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78430","type":"HCPCS"}],"standard_charges":[{"gross_charge":6738.0,"discounted_cash":4042.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78431 NM MYOCRD IMAGING PET PERFUSION REST & STRESS MULT STUDY W/CT","code_information":[{"code":"3400127","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78431","type":"HCPCS"}],"standard_charges":[{"gross_charge":10507.0,"discounted_cash":6304.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78432 NM MYOCRD IMAGING PET PERF/METAB DUAL RADIOTRACER","code_information":[{"code":"3400128","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78432","type":"HCPCS"}],"standard_charges":[{"gross_charge":12842.0,"discounted_cash":7705.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78433 NM MYOCRD IMAGING PETPERF/METAB DUAL RADIOTRACER W/CT","code_information":[{"code":"3400129","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78433","type":"HCPCS"}],"standard_charges":[{"gross_charge":12842.0,"discounted_cash":7705.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78434 NM AQMBF/ABSOLUTE QUANTIFICATION BLOOD FLOW PET REST & RX STRESS","code_information":[{"code":"3400130","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78434","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":1512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 78835 NM RADIOPHARM QUANTIFICATION MEASURE SINGLE AREA","code_information":[{"code":"3400131","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78835","type":"HCPCS"}],"standard_charges":[{"gross_charge":2784.0,"discounted_cash":1670.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THYROTROPIN ALPHA INJ  0.9MG/1.1MG VIAL","code_information":[{"code":"3430047","type":"CDM"},{"code":"0636","type":"RC"},{"code":"J3240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":1687.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70450 CT HEAD/BRAIN W/O CONTRAST","code_information":[{"code":"3500001","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70460 CT HEAD/BRAIN W/ CONTRAST","code_information":[{"code":"3500002","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2160.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3601.0,"discounted_cash":2160.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70470 CT HEAD OR BRAIN WO/W CONTRAST","code_information":[{"code":"3500003","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4115.0,"discounted_cash":2469.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4115.0,"discounted_cash":2469.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70480 CT INTRACRANIAL W/O CONTRAST","code_information":[{"code":"3500004","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":3646.0,"discounted_cash":2187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3646.0,"discounted_cash":2187.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70480 CT ORBITS W/O CONTRAST","code_information":[{"code":"3500005","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":3646.0,"discounted_cash":2187.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3646.0,"discounted_cash":2187.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70481 CT INTRACRANIAL W/ CONTRAST","code_information":[{"code":"3500006","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":3697.0,"discounted_cash":2218.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3697.0,"discounted_cash":2218.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70481 CT ORBITS W/ CONTRAST","code_information":[{"code":"3500007","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":3697.0,"discounted_cash":2218.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3697.0,"discounted_cash":2218.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70482 CT INTRACRANIAL WO/W CONTRAST","code_information":[{"code":"3500008","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70482 CT ORBITS WO/W CONTRAST","code_information":[{"code":"3500009","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70486 CT FACIAL BONES W/O CONTRAST","code_information":[{"code":"3500010","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":1915.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3193.0,"discounted_cash":1915.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70486 CT SINUS W/O CONTRAST","code_information":[{"code":"3500011","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":1915.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3193.0,"discounted_cash":1915.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70486 CT MAXILLOFACIAL W/O CONTRAST, LTD","code_information":[{"code":"3500012","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":3193.0,"discounted_cash":1915.8,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"},{"gross_charge":3193.0,"discounted_cash":1915.8,"setting":"outpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 70487 CT FACIAL BONES W/ CONTRAST","code_information":[{"code":"3500013","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":3762.0,"discounted_cash":2257.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3762.0,"discounted_cash":2257.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70487 CT SINUSES W/ CONTRAST","code_information":[{"code":"3500014","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":3762.0,"discounted_cash":2257.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3762.0,"discounted_cash":2257.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70488 CT FACIAL BONES W/WO CONTRAST","code_information":[{"code":"3500015","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70488 CT SINUSES W/WO CONTRAST","code_information":[{"code":"3500016","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70490 CT SOFT TISSUE NECK W/O CONTRAST","code_information":[{"code":"3500017","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3261.0,"discounted_cash":1956.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3261.0,"discounted_cash":1956.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70491 CT SOFT TISSUE NECK W/ CONTRAST","code_information":[{"code":"3500018","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":3748.0,"discounted_cash":2248.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3748.0,"discounted_cash":2248.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70492 CT SOFT TISSUE NECK WO/W CONTRAST","code_information":[{"code":"3500019","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":4588.0,"discounted_cash":2752.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4588.0,"discounted_cash":2752.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70496 CTA HEAD WO/W CONTRAST","code_information":[{"code":"3500020","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":4850.0,"discounted_cash":2910.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4850.0,"discounted_cash":2910.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70498 CT ANGIO NECK WO/W CONTRAST W/ IMAGE PP","code_information":[{"code":"3500021","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":4820.0,"discounted_cash":2892.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4820.0,"discounted_cash":2892.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 71250 CT THORAX DIAGNOSTIC W/O CONTRAST","code_information":[{"code":"3500022","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":3297.0,"discounted_cash":1978.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3297.0,"discounted_cash":1978.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 71260 CT THORAX DIAGNOSTIC W/ CONTRAST","code_information":[{"code":"3500025","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":3884.0,"discounted_cash":2330.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3884.0,"discounted_cash":2330.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 71270 CT THORAX DIAGNOSTIC WO/W CONTRAST","code_information":[{"code":"3500027","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":4596.0,"discounted_cash":2757.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4596.0,"discounted_cash":2757.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 71275 CT ANGIO CHST,NCRNY WO/W CONT W/ IMG PP","code_information":[{"code":"3500028","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":4604.0,"discounted_cash":2762.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4604.0,"discounted_cash":2762.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72125 CT CERVICAL SPINE W/O CONTRAST","code_information":[{"code":"3500029","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":4006.0,"discounted_cash":2403.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4006.0,"discounted_cash":2403.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72126 CT CERVICAL SPINE W/ CONTRAST","code_information":[{"code":"3500030","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":4072.0,"discounted_cash":2443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4072.0,"discounted_cash":2443.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72127 CT CERVICAL SPINE WO/W CONTRAST","code_information":[{"code":"3500031","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":4709.0,"discounted_cash":2825.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4709.0,"discounted_cash":2825.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72128 CT THORACIC SPINE W/O CONTRAST","code_information":[{"code":"3500032","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":3373.0,"discounted_cash":2023.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3373.0,"discounted_cash":2023.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72129 CT THORACIC SPINE W/ CONTRAST","code_information":[{"code":"3500033","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":3829.0,"discounted_cash":2297.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3829.0,"discounted_cash":2297.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72130 CT THORACIC SPINE WO/W CONTRAST","code_information":[{"code":"3500034","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":4407.0,"discounted_cash":2644.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4407.0,"discounted_cash":2644.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72131 CT LUMBAR SPINE W/O CONTRAST","code_information":[{"code":"3500035","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":3370.0,"discounted_cash":2022.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3370.0,"discounted_cash":2022.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72132 CT LUMBAR SPINE W/CONTRAST","code_information":[{"code":"3500036","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":3960.0,"discounted_cash":2376.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3960.0,"discounted_cash":2376.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72133 CT LUMBAR SPINE WO/W CONTRAST","code_information":[{"code":"3500037","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":4940.0,"discounted_cash":2964.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4940.0,"discounted_cash":2964.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72191 CT ANGIO PELVIS, WO/W CONTRAST W/ IMG PP","code_information":[{"code":"3500038","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72191","type":"HCPCS"}],"standard_charges":[{"gross_charge":4062.0,"discounted_cash":2437.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4062.0,"discounted_cash":2437.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72192 CT PELVIS W/O CONTRAST","code_information":[{"code":"3500039","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72193 CT PELVIS W/ CONTRAST","code_information":[{"code":"3500040","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":3545.0,"discounted_cash":2127.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3545.0,"discounted_cash":2127.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 72194 CT PELVIS WO/W CONTRAST","code_information":[{"code":"3500041","type":"CDM"},{"code":"0350","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":4094.0,"discounted_cash":2456.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4094.0,"discounted_cash":2456.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 73200 CT UPPER EXTREMITY W/O CONTRAST-RT","code_information":[{"code":"3500043","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3759.0,"discounted_cash":2255.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3759.0,"discounted_cash":2255.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73200 CT UPPER EXTREMITY W/O CONTRAST-LT","code_information":[{"code":"3500044","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3759.0,"discounted_cash":2255.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3759.0,"discounted_cash":2255.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73200 CT UPPER EXTREMITY W/O CONTRAST-BLT","code_information":[{"code":"3500045","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5639.0,"discounted_cash":3383.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":5639.0,"discounted_cash":3383.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73201 CT UPPER EXTREMITY W/ CONTRAST-RT","code_information":[{"code":"3500046","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":4139.0,"discounted_cash":2483.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4139.0,"discounted_cash":2483.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73201 CT UPPER EXTREMITY W/ CONTRAST-LT","code_information":[{"code":"3500047","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":4139.0,"discounted_cash":2483.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4139.0,"discounted_cash":2483.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73201 CT UPPER EXTREMITY W/ CONTRAST-BLT","code_information":[{"code":"3500048","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":6209.0,"discounted_cash":3725.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6209.0,"discounted_cash":3725.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73202 CT UPPER EXTREMITY WO/W CONTRAST-RT","code_information":[{"code":"3500049","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":3918.0,"discounted_cash":2350.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3918.0,"discounted_cash":2350.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73202 CT UPPER EXTREMITY WO/W CONTRAST-LT","code_information":[{"code":"3500050","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":3918.0,"discounted_cash":2350.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3918.0,"discounted_cash":2350.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73202 CT UPPER EXTREMITY WO/W CONTRAST-BLT","code_information":[{"code":"3500051","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73202","type":"HCPCS"}],"standard_charges":[{"gross_charge":5877.0,"discounted_cash":3526.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":5877.0,"discounted_cash":3526.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73206 CT ANGIO UP EXTREM WO/W CONTR W/ PP-RT","code_information":[{"code":"3500052","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":4156.0,"discounted_cash":2493.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4156.0,"discounted_cash":2493.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73206 CT ANGIO UP EXTREM WO/W CONTR W/ PP-LT","code_information":[{"code":"3500053","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":4156.0,"discounted_cash":2493.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4156.0,"discounted_cash":2493.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73206 CT ANGIO UP EXTREM WO/W CONTR W/ PP-BLT","code_information":[{"code":"3500054","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":6234.0,"discounted_cash":3740.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6234.0,"discounted_cash":3740.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73700 CT LOWER EXTREM W/O CONTRAST RT","code_information":[{"code":"3500055","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3135.0,"discounted_cash":1881.0,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73700 CT LOWER EXTREM W/O CONTRAST LT","code_information":[{"code":"3500056","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3135.0,"discounted_cash":1881.0,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73700 CT LOWER EXTREM W/O CONTRAST BLT","code_information":[{"code":"3500057","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.0,"discounted_cash":2822.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":4704.0,"discounted_cash":2822.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73701 CT LOWER EXTREM W/ CONTRAST RT","code_information":[{"code":"3500058","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.0,"discounted_cash":2099.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3499.0,"discounted_cash":2099.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73701 CT LOWER EXTREM W/ CONTRAST LT","code_information":[{"code":"3500059","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.0,"discounted_cash":2099.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3499.0,"discounted_cash":2099.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73701 CT LOWER EXTREM W/CONTRAST BLT","code_information":[{"code":"3500060","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":5247.0,"discounted_cash":3148.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":5247.0,"discounted_cash":3148.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73702 CT LOWER EXTREM WO/W CONTRAST RT","code_information":[{"code":"3500061","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":4453.0,"discounted_cash":2671.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4453.0,"discounted_cash":2671.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73702 CT LOWER EXTREM WO/W CONTRAST LT","code_information":[{"code":"3500062","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":4453.0,"discounted_cash":2671.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4453.0,"discounted_cash":2671.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73702 CT LOWER EXTREM WO/W CONTRAST BLT","code_information":[{"code":"3500063","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":6679.0,"discounted_cash":4007.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6679.0,"discounted_cash":4007.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73706 CT ANGIO, LOW EXT WO/W CONTRAST W/ PP RT","code_information":[{"code":"3500064","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":4614.0,"discounted_cash":2768.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4614.0,"discounted_cash":2768.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73706 CT ANGIO, LOW EXTREM WO/W CONT W/PP-LT","code_information":[{"code":"3500065","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":4614.0,"discounted_cash":2768.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":4614.0,"discounted_cash":2768.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73706 CT ANGIO, LOW EXTREM WO/W CONT W/PP-BLT","code_information":[{"code":"3500066","type":"CDM"},{"code":"0350","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":6920.0,"discounted_cash":4152.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6920.0,"discounted_cash":4152.0,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 74150 CT ABDOMEN W/O CONTRAST","code_information":[{"code":"3500067","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":3232.0,"discounted_cash":1939.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3232.0,"discounted_cash":1939.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74160 CT ABDOMEN W/ CONTRAST","code_information":[{"code":"3500068","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":3499.0,"discounted_cash":2099.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3499.0,"discounted_cash":2099.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74170 CT ABDOMEN WO/W CONTRAST","code_information":[{"code":"3500069","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":3692.0,"discounted_cash":2215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3692.0,"discounted_cash":2215.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74175 CT ANGIO ABDOMEN WO/W CONTRAST W/ IMG PP","code_information":[{"code":"3500070","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":3894.0,"discounted_cash":2336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3894.0,"discounted_cash":2336.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 75635 CTA ABD AORTA BILAT ILIOFEMORAL W/WO","code_information":[{"code":"3500071","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4131.0,"discounted_cash":2478.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4131.0,"discounted_cash":2478.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 75984 CT CHANGE PERC TUBE W/CONTRAST","code_information":[{"code":"3500072","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 75989 CT PERC DRAIN ABSCESS W/PLACE CATH","code_information":[{"code":"3500073","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76376 CT RECONSTRUHC CTION,NO PP ON INDEPENDT WK","code_information":[{"code":"3500074","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76377 CT RECONSTRUCT W PP ON INDEPENDT WORKSTATION","code_information":[{"code":"3500075","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76380 CT LIMITED OR LOCAL FOLLOW-UP, LEVEL I","code_information":[{"code":"3500076","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76380 CT LIMITED OR LOCAL FOLLOW-UP, LEVEL II","code_information":[{"code":"3500077","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76380 CT LIMITED OR LOCAL FOLLOW-UP, LEVEL III","code_information":[{"code":"3500078","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76497 CT UNLISTED PROCEDURE","code_information":[{"code":"3500079","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76497","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77011 CT GUIDE, STEROTAHC CTIC LOCAL","code_information":[{"code":"3500080","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 77012 CT GUIDE NEEDLE,BIOPSY/ASPIRATION","code_information":[{"code":"3500081","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 77013 CT GUIDED/MONTR, VISCERAL TISUE ABLATION","code_information":[{"code":"3500082","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 77078 CT,BONE DENSITY 1OR MORE SITE AXIAL SKEL","code_information":[{"code":"3500085","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77078","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74261 CT COLONSCOPY,W/O CONTRAST DIAGNOSTIC","code_information":[{"code":"3500098","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74261","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74262 CT COLONSCOPY,W/CONTRAST DIAGNOSTIC","code_information":[{"code":"3500099","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74262","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 75571 CT-HEART,W/O CONTRAST,W/QUANT EVAL","code_information":[{"code":"3500100","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75572 CT-HEART,W/CONTRAST MORPHOLOGY","code_information":[{"code":"3500101","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75572","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 75573 CT-HEART,W/CNTRST MORPHOLOGY CONGENTIAL","code_information":[{"code":"3500102","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75573","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 75574 CT-CCTA,HEART W/CONTRAST FUNCTION","code_information":[{"code":"3500103","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":3458.0,"discounted_cash":2074.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3458.0,"discounted_cash":2074.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74263 CT COLONGRAPHY,SCN INC IMAGES POST PROCES","code_information":[{"code":"3500104","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74263","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74176 CT ABD AND PELVIS, WITHOUT CONTRAST","code_information":[{"code":"3500105","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":4492.0,"discounted_cash":2695.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4492.0,"discounted_cash":2695.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74177 CT ABD AND PELVIS, WITH CONTRAST","code_information":[{"code":"3500106","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":5227.0,"discounted_cash":3136.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5227.0,"discounted_cash":3136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74178 CT ABD & PLVS W & WO CONT  1 BODY REGN","code_information":[{"code":"3500107","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":5593.0,"discounted_cash":3355.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5593.0,"discounted_cash":3355.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74174 CT ANGIOGRAPHY ABD/PELVIS W CONTRAST","code_information":[{"code":"3500109","type":"CDM"},{"code":"0350","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":5869.0,"discounted_cash":3521.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5869.0,"discounted_cash":3521.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD RT","code_information":[{"code":"3500110","type":"CDM"},{"code":"0350","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3135.0,"discounted_cash":1881.0,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD LT","code_information":[{"code":"3500111","type":"CDM"},{"code":"0350","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":3135.0,"discounted_cash":1881.0,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD BLT","code_information":[{"code":"3500112","type":"CDM"},{"code":"0350","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.0,"discounted_cash":2822.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":4704.0,"discounted_cash":2822.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 49405 CT-GUIDED DRAINAGE VISCERAL","code_information":[{"code":"3500113","type":"CDM"},{"code":"0350","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":4233.0,"discounted_cash":2539.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4233.0,"discounted_cash":2539.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 49406 CT-GUIDED DRN PERITONEAL/RETROPERITONEAL","code_information":[{"code":"3500114","type":"CDM"},{"code":"0350","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4137.0,"discounted_cash":2482.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":4137.0,"discounted_cash":2482.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 49407 CT-GUIDED DRN PERITONEAL/RETRO TR/TV","code_information":[{"code":"3500115","type":"CDM"},{"code":"0350","type":"RC"},{"code":"49407","type":"HCPCS"}],"standard_charges":[{"gross_charge":5070.0,"discounted_cash":3042.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5070.0,"discounted_cash":3042.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 10030 CT-GUIDED DRAINAGE SOFT TISSUE PERC","code_information":[{"code":"3500116","type":"CDM"},{"code":"0350","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":3655.0,"discounted_cash":2193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3655.0,"discounted_cash":2193.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 10009 FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION","code_information":[{"code":"3500121","type":"CDM"},{"code":"0350","type":"RC"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":3912.0,"discounted_cash":2347.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3912.0,"discounted_cash":2347.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 10010 FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL","code_information":[{"code":"3500122","type":"CDM"},{"code":"0350","type":"RC"},{"code":"10010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3135.0,"discounted_cash":1881.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 71271 CT THORAX W/O CONTRAST - SCREENING","code_information":[{"code":"3500123","type":"CDM"},{"code":"0350","type":"RC"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0722T QUAN CT TISS CHARAC I&R WITH CONCURRENT CT EXAM","code_information":[{"code":"3500124","type":"CDM"},{"code":"0350","type":"RC"},{"code":"0722T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3358.0,"discounted_cash":2014.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":3167.0,"discounted_cash":1900.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70471 CTA HEAD & NECK W/& WO CONTRAST IMGS & IMG POST PROCESSING","code_information":[{"code":"3500129","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70471","type":"HCPCS"}],"standard_charges":[{"gross_charge":3233.0,"discounted_cash":1939.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70472 CT CEREBRAL PERFUS ALYS W/CONTRAST W/CT/CTA SAME ANATOMY, SEP PROC","code_information":[{"code":"3500130","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70472","type":"HCPCS"}],"standard_charges":[{"gross_charge":2855.0,"discounted_cash":1713.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 70473 CT CEREBRAL PERFUS ALYS W/CONTRAST IMG W/O CT/CTA SAME ANATOMY","code_information":[{"code":"3500131","type":"CDM"},{"code":"0350","type":"RC"},{"code":"70473","type":"HCPCS"}],"standard_charges":[{"gross_charge":2855.0,"discounted_cash":1713.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, 1ST 30 MINUTES LEVEL I","code_information":[{"code":"3600001","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600001","type":"HCPCS"}],"standard_charges":[{"gross_charge":5769.0,"discounted_cash":3461.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, 1ST 30 MINUTES LEVEL II","code_information":[{"code":"3600002","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600002","type":"HCPCS"}],"standard_charges":[{"gross_charge":6058.0,"discounted_cash":3634.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, 1ST 30 MINUTES LEVEL III","code_information":[{"code":"3600003","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600003","type":"HCPCS"}],"standard_charges":[{"gross_charge":6360.0,"discounted_cash":3816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, 1ST 30 MINUTES LEVEL IV","code_information":[{"code":"3600004","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600004","type":"HCPCS"}],"standard_charges":[{"gross_charge":6679.0,"discounted_cash":4007.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, 1ST 30 MINUTES LEVEL V","code_information":[{"code":"3600005","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600005","type":"HCPCS"}],"standard_charges":[{"gross_charge":7146.0,"discounted_cash":4287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, 1ST 30 MINUTES LEVEL VI","code_information":[{"code":"3600006","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600006","type":"HCPCS"}],"standard_charges":[{"gross_charge":7646.0,"discounted_cash":4587.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, EA ADD'L 30 MIN LEVEL I","code_information":[{"code":"3600007","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600007","type":"HCPCS"}],"standard_charges":[{"gross_charge":3347.0,"discounted_cash":2008.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, EA ADD'L 30 MIN LEVEL II","code_information":[{"code":"3600008","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600008","type":"HCPCS"}],"standard_charges":[{"gross_charge":3447.0,"discounted_cash":2068.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, EA ADD'L 30 MIN LEVEL III","code_information":[{"code":"3600010","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3550.0,"discounted_cash":2130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, EA ADD'L 30 MIN LEVEL IV","code_information":[{"code":"3600011","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3657.0,"discounted_cash":2194.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, EA ADD'L 30 MIN LEVEL V","code_information":[{"code":"3600012","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3767.0,"discounted_cash":2260.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PUMP PERFUSION SERVICE","code_information":[{"code":"3600013","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600013","type":"HCPCS"}],"standard_charges":[{"gross_charge":7386.0,"discounted_cash":4431.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGERY, EA ADD'L 30 MIN LEVEL VI","code_information":[{"code":"3600015","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600015","type":"HCPCS"}],"standard_charges":[{"gross_charge":3880.0,"discounted_cash":2328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,EPIDURAL SINGLE, CERVICAL/THORACIC","code_information":[{"code":"3600018","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600018","type":"HCPCS"}],"standard_charges":[{"gross_charge":2650.0,"discounted_cash":1590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,EPIDURAL SINGLE, LUMBAR/SACRAL","code_information":[{"code":"3600019","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600019","type":"HCPCS"}],"standard_charges":[{"gross_charge":2650.0,"discounted_cash":1590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,CATH PLACE CON'T INFS/BLS CERVICAL/THORACIC","code_information":[{"code":"3600020","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3845.0,"discounted_cash":2307.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,CATH PLACE CON'T INFS/BLS LUMBAR/SACRAL","code_information":[{"code":"3600021","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600021","type":"HCPCS"}],"standard_charges":[{"gross_charge":3662.0,"discounted_cash":2197.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,ANES AGENT;TRIGEMINAL NERVE","code_information":[{"code":"3600022","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600022","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,ANES AGNT; FACIAL NERVE","code_information":[{"code":"3600023","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600023","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,ANES AGENT;GREATER OCCIPATAL NERVE","code_information":[{"code":"3600024","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600024","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,ANES AGNT;BRACHIAL PLEXUS NERVE","code_information":[{"code":"3600025","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600025","type":"HCPCS"}],"standard_charges":[{"gross_charge":6255.0,"discounted_cash":3753.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ, ANES;BRACHIAL PLEXUS CON'T INF BY CATH","code_information":[{"code":"3600026","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600026","type":"HCPCS"}],"standard_charges":[{"gross_charge":2607.0,"discounted_cash":1564.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ, ANES AGNT;INTERCOSTAL NERVE;SNGL","code_information":[{"code":"3600027","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600027","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,ANES AGNT;INTERCOSTAL NERVE MULT REG BLOCK","code_information":[{"code":"3600028","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600028","type":"HCPCS"}],"standard_charges":[{"gross_charge":2401.0,"discounted_cash":1440.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES AGNT;ILIOINGUINAL/ILIOHHYPOGASTRIC NERVE","code_information":[{"code":"3600029","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600029","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES AGNT;SIATIC NERVE","code_information":[{"code":"3600030","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2650.0,"discounted_cash":1590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES AGNT,OTHER PERIPH NERVE/BLOCK","code_information":[{"code":"3600031","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":609.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES/STRD NERV;TRNSFRM;CERVICAL/THORACIC;SNGL","code_information":[{"code":"3600032","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600032","type":"HCPCS"}],"standard_charges":[{"gross_charge":2650.0,"discounted_cash":1590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES/STRD NERV;TRNSFRM;CERVICAL/THORACIC;EA ADD'L","code_information":[{"code":"3600033","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600033","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES/STRD NRV;TRANSRM;LUMBR/SACRAL SNGL","code_information":[{"code":"3600034","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2650.0,"discounted_cash":1590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES/STRD NRV;TRANSRM;LUMBR/SACRAL EA ADD'L","code_information":[{"code":"3600035","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600035","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,ANES AGNT;STELLATE GANGLION","code_information":[{"code":"3600036","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600036","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ,ANES AGNT;LUMBAR/THORACIC","code_information":[{"code":"3600037","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2650.0,"discounted_cash":1590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES AGNT;CELIAC PLEXUS","code_information":[{"code":"3600038","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600038","type":"HCPCS"}],"standard_charges":[{"gross_charge":3315.0,"discounted_cash":1989.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJECTION ANES AGENT FEMORAL NERVE SINGLE","code_information":[{"code":"3600046","type":"CDM"},{"code":"0360","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2034.0,"discounted_cash":1220.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PUMP PERFUSION SERVICE STAND-BY","code_information":[{"code":"3600047","type":"CDM"},{"code":"0360","type":"RC"},{"code":"3600047","type":"HCPCS"}],"standard_charges":[{"gross_charge":3921.0,"discounted_cash":2352.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36483 ENDO ABLAT THERAPY CHEM ADHES SBSQ","code_information":[{"code":"3600065","type":"CDM"},{"code":"0360","type":"RC"},{"code":"36483","type":"HCPCS"}],"standard_charges":[{"gross_charge":6934.0,"discounted_cash":4160.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31645 BRONCHOSCOPY W/THERAPEUTIC ASPIRATION","code_information":[{"code":"3600095","type":"CDM"},{"code":"0360","type":"RC"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":3758.0,"discounted_cash":2254.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31646 BRONCHOSCOPY W/THER ASPIRATION SUBQ","code_information":[{"code":"3600102","type":"CDM"},{"code":"0360","type":"RC"},{"code":"31646","type":"HCPCS"}],"standard_charges":[{"gross_charge":3601.0,"discounted_cash":2160.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10060 I&D OF ABSCESS-SIMPLE/SINGLE","code_information":[{"code":"3610003","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1333.0,"discounted_cash":799.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10061 I&D OF ABSCESS-COMPLEX/MULTIPLE","code_information":[{"code":"3610004","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10120 INC/REMOVE FB SUBCUT SIMPLE","code_information":[{"code":"3610006","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.0,"discounted_cash":916.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10140 I&D HEMATOMA SEROMA OR FLUID COLLECT","code_information":[{"code":"3610007","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":4838.0,"discounted_cash":2902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10160 PUNCTURE/ASP OF ABCESS, HEMATOMA,CYST","code_information":[{"code":"3610008","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1417.0,"discounted_cash":850.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10180 I&D COMPLEX, POST OP WOUND INFECT","code_information":[{"code":"3610009","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":7788.0,"discounted_cash":4672.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRIM SINGLE BENIGN SKIN LESION","code_information":[{"code":"3610010","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRIM 2-4 BENIGN SKIN LESIONS","code_information":[{"code":"3610011","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRIM>4 BENIGN SKIN LESIONS","code_information":[{"code":"3610012","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":829.0,"discounted_cash":497.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC BEN LES OTHER <=.5CM","code_information":[{"code":"3610032","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":5295.0,"discounted_cash":3177.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC BEN LES OTHER .6 TO 1CM","code_information":[{"code":"3610033","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":5329.0,"discounted_cash":3197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC BEN LES OTHER 1.1 TO 2CM","code_information":[{"code":"3610034","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":5617.0,"discounted_cash":3370.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC BEN LES OTHER 2.1 TO 3CM","code_information":[{"code":"3610035","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":7216.0,"discounted_cash":4329.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRIMING NONDYSTROPHIC  NAILS","code_information":[{"code":"3610049","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEBRIDEMENT OF NAILS,1-5","code_information":[{"code":"3610050","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEBRIDEMENT OF NAILS,>/= 6","code_information":[{"code":"3610051","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AVULSION NAIL,SINGLE","code_information":[{"code":"3610052","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":291.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AVULSION EACH ADD NAIL","code_information":[{"code":"3610053","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.0,"discounted_cash":272.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11750 EXCISION NAIL & MATRIX","code_information":[{"code":"3610054","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2211.0,"discounted_cash":1326.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12001 SIM REP,SLP,NCK,AXL,TRK,EXT<=2.5","code_information":[{"code":"3610056","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":562.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12002 SIM REP,SLP,NCK,AXL,TRK,EXT 2.6-7.5","code_information":[{"code":"3610057","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12031 LAYER CLOS,SCLP,AXL,TRK,EXTM<=2.5","code_information":[{"code":"3610059","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1676.0,"discounted_cash":1005.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12032 LAYER CLOS,SCLP,AXL,TRK,EXT,2.6-7.5","code_information":[{"code":"3610060","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1749.0,"discounted_cash":1049.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12034 LAYER CLOS,SCLP,AXL,TRK,EXT,7.6-12.5","code_information":[{"code":"3610061","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1287.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGICAL PREP < 100 SQ CM","code_information":[{"code":"3610062","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":1268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 16020 DRESS/DEBRID,BURN W/O ANEST,SMALL","code_information":[{"code":"3610067","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.0,"discounted_cash":552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEST WART BENIGN LESION 1ST","code_information":[{"code":"3610068","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17000","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DESTROY BENIGN LESION 2-14 LESIONS-EACH","code_information":[{"code":"3610069","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17003","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 17250 CHEM CAUTERIZATION GRANDULATION TISSUE","code_information":[{"code":"3610072","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":411.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PUNCH ASP CYST BREAST-LT","code_information":[{"code":"3610074","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.0,"discounted_cash":964.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PUNCH ASP CYST BREAST-RT","code_information":[{"code":"3610075","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.0,"discounted_cash":964.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PUNCH ASP CYST BREAST-BLT","code_information":[{"code":"3610076","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2593.0,"discounted_cash":1555.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PUNCH ASP CYST BREAST EA ADL-LT","code_information":[{"code":"3610077","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":597.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PUNCH ASP CYST BREAST EA ADL-RT","code_information":[{"code":"3610078","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":597.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PUNCH ASP CYST BREAST EA ADL-BLT","code_information":[{"code":"3610079","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1487.0,"discounted_cash":892.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 19030 INJ PRO MAMMARY DUCTOGRAM-LT","code_information":[{"code":"3610080","type":"CDM"},{"code":"0320","type":"RC"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":528.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 19030 INJ PRO MAMMARY DUCTOGRAM-RT","code_information":[{"code":"3610081","type":"CDM"},{"code":"0320","type":"RC"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":528.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 19030 INJ PRO MAMMARY DUCTOGRAM-BLT","code_information":[{"code":"3610082","type":"CDM"},{"code":"0320","type":"RC"},{"code":"19030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":787.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20206 BIOPSY MUSCLE PERC - NEEDLE","code_information":[{"code":"3610102","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3314.0,"discounted_cash":1988.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20220 BIOPSY BONE, TROCAR/NEEDLE SUPRFICIAL","code_information":[{"code":"3610103","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6814.0,"discounted_cash":4088.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20225 BIOPSY BONE, TROCAR/NEEDLE DEEP","code_information":[{"code":"3610104","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":8320.0,"discounted_cash":4992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20240 BIOPSY BONE,OPEN,EXCISION-SUPERFICIAL WC","code_information":[{"code":"3610105","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":7391.0,"discounted_cash":4434.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20245 BIOPSY BONE,OPEN,EXCISION-DEEP WC","code_information":[{"code":"3610106","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20245","type":"HCPCS"}],"standard_charges":[{"gross_charge":9468.0,"discounted_cash":5680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20500 INJ SINUS TRACT THERAPEUTIC","code_information":[{"code":"3610107","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2544.0,"discounted_cash":1526.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20501 INJ SINUS TRACT DIAG/SINOGRAM","code_information":[{"code":"3610108","type":"CDM"},{"code":"0320","type":"RC"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":1754.0,"discounted_cash":1052.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC APPLICATION CRANIAL TONGS/CALIP/STEREOFRAME","code_information":[{"code":"3610119","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20660","type":"HCPCS"}],"standard_charges":[{"gross_charge":2605.0,"discounted_cash":1563.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL OF TONGS/HALO APPLIED BY DIFF MD","code_information":[{"code":"3610121","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20665","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":376.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20982 ABLATION BONE TUMOR-RADIO FREQ PERC CT GUIDED","code_information":[{"code":"3610122","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20982","type":"HCPCS"}],"standard_charges":[{"gross_charge":15803.0,"discounted_cash":9481.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21550 BIOPSY-SOFT TISSUE OF NECK OR THORAX","code_information":[{"code":"3610123","type":"CDM"},{"code":"0361","type":"RC"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":7497.0,"discounted_cash":4498.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23350 INJ PRO SHOULDER ARTH/CT/MRI-LT","code_information":[{"code":"3610133","type":"CDM"},{"code":"0320","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.0,"discounted_cash":841.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23350 INJ PRO SHOULDER ARTH/CT/MRI-RT","code_information":[{"code":"3610134","type":"CDM"},{"code":"0320","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1403.0,"discounted_cash":841.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24220 INJ PRO ELBOW ARTHROGRAPHY-LT","code_information":[{"code":"3610136","type":"CDM"},{"code":"0320","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":754.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24220 INJ PRO ELBOW ARTHROGRAPHY-RT","code_information":[{"code":"3610137","type":"CDM"},{"code":"0320","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":754.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25246 INJ PRO WRIST ARTHROGRAPHY-LT","code_information":[{"code":"3610138","type":"CDM"},{"code":"0320","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":790.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25246 INJ PRO WRIST ARTHROGRAPHY-RT","code_information":[{"code":"3610139","type":"CDM"},{"code":"0320","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":790.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27093 INJ PRO HIP ARTHRO W/O ANES-LT","code_information":[{"code":"3610142","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":685.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27093 INJ PRO HIP ARTHRO W/O ANES-RT","code_information":[{"code":"3610143","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":685.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27095 INJ PRO HIP ARTHRO W ANES-RT","code_information":[{"code":"3610144","type":"CDM"},{"code":"0320","type":"RC"},{"code":"27095","type":"HCPCS"}],"standard_charges":[{"gross_charge":1432.0,"discounted_cash":859.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27095 INJ PRO HIP ARTHRO W ANES-LT","code_information":[{"code":"3610145","type":"CDM"},{"code":"0320","type":"RC"},{"code":"27095","type":"HCPCS"}],"standard_charges":[{"gross_charge":1432.0,"discounted_cash":859.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27648 INJ PRO ANKLE ARTHROGRAPHY-LT","code_information":[{"code":"3610150","type":"CDM"},{"code":"0320","type":"RC"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":754.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27648 INJ PRO ANKLE ARTHROGRAPHY-RT","code_information":[{"code":"3610151","type":"CDM"},{"code":"0320","type":"RC"},{"code":"27648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":754.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC STRAPING ,UNNA BOOT RT","code_information":[{"code":"3610152","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC STRAPING ,UNNA BOOT LT","code_information":[{"code":"3610153","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC STRAPING ,UNNA BOOT BLT","code_information":[{"code":"3610154","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":468.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE","code_information":[{"code":"3610156","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1122.0,"discounted_cash":673.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31622 BRONCHOSCOPY  DIAG W OR W/O CELL WASHING","code_information":[{"code":"3610160","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":4287.0,"discounted_cash":2572.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31623 BRONCHOSCOPY W/ BRUSHINGS","code_information":[{"code":"3610161","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31623","type":"HCPCS"}],"standard_charges":[{"gross_charge":2757.0,"discounted_cash":1654.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31624 BRONCHOSCOPY W/BRONCH ALVEOLAR LAVAGE","code_information":[{"code":"3610162","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":2998.0,"discounted_cash":1798.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31625 BRONCHOSCOPY W/BRONCHIAL OR ENDO BIOPSY","code_information":[{"code":"3610163","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31625","type":"HCPCS"}],"standard_charges":[{"gross_charge":3519.0,"discounted_cash":2111.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31628 BRONCHOSCOPY W/TRANSBRONCIAL LUNG BX, EACH","code_information":[{"code":"3610164","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31628","type":"HCPCS"}],"standard_charges":[{"gross_charge":3881.0,"discounted_cash":2328.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31629 BRONCHOSCOPY W/NEEDLE ASPIRATION","code_information":[{"code":"3610165","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31629","type":"HCPCS"}],"standard_charges":[{"gross_charge":4726.0,"discounted_cash":2835.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31630 BRONCHOSCOPY W/TRACHEAL DILATATION/CLOSED REDUCTION","code_information":[{"code":"3610166","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31630","type":"HCPCS"}],"standard_charges":[{"gross_charge":6197.0,"discounted_cash":3718.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31631 BRONCHOSCOPY W/TRACH DILATION /STENT PLACEMENT","code_information":[{"code":"3610167","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31631","type":"HCPCS"}],"standard_charges":[{"gross_charge":8091.0,"discounted_cash":4854.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31632 BRONCHOSCOPY W/TRANSBRONCIAL LUNG BIOPSY","code_information":[{"code":"3610168","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31632","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.0,"discounted_cash":1445.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31633 BRONCHOSCOPY W/TRANSBRONCIAL NEEDLE BX","code_information":[{"code":"3610169","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3160.0,"discounted_cash":1896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31635 BRONCHOSCOPY W W/O FLURO W/ REMOVAL FB","code_information":[{"code":"3610170","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3146.0,"discounted_cash":1887.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CATH ASPIRATION, NASOTRACHEAL","code_information":[{"code":"3610172","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":206.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32400 BIOPSY PLEURA PERCUTANEOUS -  NEEDLE","code_information":[{"code":"3610174","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2049.0,"discounted_cash":1229.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32550 PLEURAL CATH INSERTION TUNNELED W/CUFF","code_information":[{"code":"3610180","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":13085.0,"discounted_cash":7851.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32551 CHEST TUBE INSERTION RIGHT","code_information":[{"code":"3610181","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1808.0,"discounted_cash":1084.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32551 CHEST TUBE INSERTION LEFT","code_information":[{"code":"3610182","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1808.0,"discounted_cash":1084.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 33206 INS NEW OR REPLACE PERM PACEMAKER ATRIAL","code_information":[{"code":"3610190","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33206","type":"HCPCS"}],"standard_charges":[{"gross_charge":25556.0,"discounted_cash":15333.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33207 INS NEW OR REPLACE PERM PACEMAKER VENTRCL","code_information":[{"code":"3610191","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":23742.0,"discounted_cash":14245.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33208 INS NEW OR REPLACE PERM PACEMKR ATRIAL&VENT","code_information":[{"code":"3610192","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":25389.0,"discounted_cash":15233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33210 INS/REPLACTMP SGL CHMB ELEC/PMKR CATH","code_information":[{"code":"3610193","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":13515.0,"discounted_cash":8109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33212 INSERT PULSE GENERATOR; W/ EXIST SGL LEAD","code_information":[{"code":"3610194","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33212","type":"HCPCS"}],"standard_charges":[{"gross_charge":21322.0,"discounted_cash":12793.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33213 INSERT PULSE GENERATOR; W/ EXIST DUAL LEADS","code_information":[{"code":"3610195","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33213","type":"HCPCS"}],"standard_charges":[{"gross_charge":23040.0,"discounted_cash":13824.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33214 UPGRD IMPLT PMKR SINGLE TO DUAL","code_information":[{"code":"3610196","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33214","type":"HCPCS"}],"standard_charges":[{"gross_charge":29289.0,"discounted_cash":17573.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33216 INSERT SINGLE TRANSVENOUS ELECTRODE","code_information":[{"code":"3610197","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":13894.0,"discounted_cash":8336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33217 INSERTION OF 2 TRANSVENOUS ELECTRODES","code_information":[{"code":"3610198","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":13894.0,"discounted_cash":8336.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33218 REPAIR SGL ELECTRODE PERM PACEMAKER/ICD","code_information":[{"code":"3610199","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33218","type":"HCPCS"}],"standard_charges":[{"gross_charge":7130.0,"discounted_cash":4278.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33220 REPAIR 2 ELECTRODES PERM PACEMAKER/ICD","code_information":[{"code":"3610200","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33220","type":"HCPCS"}],"standard_charges":[{"gross_charge":7902.0,"discounted_cash":4741.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33222 RELOCATION OF SKIN POCKET FOR PACEMAKER","code_information":[{"code":"3610201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3065.0,"discounted_cash":1839.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33223 REVISION SKIN POCKT SNGL/DUAL CHAMB","code_information":[{"code":"3610202","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4885.0,"discounted_cash":2931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33233 REMOVAL PERM PACEMKER PULSE GENERATOR ONLY","code_information":[{"code":"3610203","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":9447.0,"discounted_cash":5668.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33234 REMOVAL PACEMAKER ELECT SNGL LEAD","code_information":[{"code":"3610204","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":5701.0,"discounted_cash":3420.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33235 REMOVAL PACEMAKER ELECT DUAL LEAD","code_information":[{"code":"3610205","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":5701.0,"discounted_cash":3420.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33240 INSERT ICD PULSE GEN ONLY W/ EXIST SGL LEAD","code_information":[{"code":"3610206","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33240","type":"HCPCS"}],"standard_charges":[{"gross_charge":43419.0,"discounted_cash":26051.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33241 REMOVAL  PACING ICD PULSE GENERATOR ONLY","code_information":[{"code":"3610207","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":4885.0,"discounted_cash":2931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33244 REMOVAL SINGLE/DUAL DEFIB VENOUS","code_information":[{"code":"3610208","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33244","type":"HCPCS"}],"standard_charges":[{"gross_charge":4885.0,"discounted_cash":2931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33249 INSERT/REPLACE PERM ICD W/LEADS SGL/DUAL","code_information":[{"code":"3610209","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":44680.0,"discounted_cash":26808.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33967 BALLOON PUMP INSERTION PERCUTANEOUS","code_information":[{"code":"3610217","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":2470.0,"discounted_cash":1482.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36000 INTRO NEEDLE OR INTRACATH, VEIN","code_information":[{"code":"3610285","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1687.0,"discounted_cash":1012.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ PROC TX (THROMBIN)EXTRMTY PSEUDOANEURS LT","code_information":[{"code":"3610286","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":652.0,"discounted_cash":391.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INJ PROC TX (THROMBIN)EXTRMITY PSEUDOANEURS RT","code_information":[{"code":"3610287","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":400.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36005 INJ PROC EXTRMTY VENOGRAM","code_information":[{"code":"3610290","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1791.0,"discounted_cash":1074.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36010 INTRO CATH SUPR/INFR VENA CAVA","code_information":[{"code":"3610291","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36011 SEL CATH PLC VENOUS 1ST ORDR-LT","code_information":[{"code":"3610292","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3037.0,"discounted_cash":1822.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36011 SEL CATH PLC VENOUS 1ST ORDR-RT","code_information":[{"code":"3610293","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3037.0,"discounted_cash":1822.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36011 SEL CATH PLC VENOUS 1ST ORDR-BLT","code_information":[{"code":"3610294","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":2733.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36012 SEL CATH PLC VENOUS 2ND ORD-LT","code_information":[{"code":"3610295","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3443.0,"discounted_cash":2065.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36012 SEL CATH PLC VENOUS 2ND ORD-RT","code_information":[{"code":"3610296","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3443.0,"discounted_cash":2065.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36012 SEL CATH PLC VENOUS 2ND ORD-BLT","code_information":[{"code":"3610297","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36012","type":"HCPCS"}],"standard_charges":[{"gross_charge":5165.0,"discounted_cash":3099.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36013 INTRO CATH RT HEART/PULM ART","code_information":[{"code":"3610298","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36013","type":"HCPCS"}],"standard_charges":[{"gross_charge":2387.0,"discounted_cash":1432.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36014 SEL CATH PLC LT/RT PULM ART-LT","code_information":[{"code":"3610299","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":852.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36014 SEL CATH PLC LT/RT PULM ART-RT","code_information":[{"code":"3610300","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":852.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36014 SEL CATH PLC LT/RT PULM ART-BLT","code_information":[{"code":"3610301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":2006.0,"discounted_cash":1203.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC SEL CATH PLC SEG/SUB PULM ART-LT","code_information":[{"code":"3610302","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":935.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SEL CATH PLC SEG/SUB PULM ART-RT","code_information":[{"code":"3610303","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1559.0,"discounted_cash":935.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SEL CATH PLC SEG/SUB PULM ART-BLT","code_information":[{"code":"3610304","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":2827.0,"discounted_cash":1696.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36140 INTRO NEEDLE/CATH UPPER/LOWER EXTREMITY ART","code_information":[{"code":"3610308","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1344.0,"discounted_cash":806.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36200 INTRO  CATH AORTA","code_information":[{"code":"3610311","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1874.0,"discounted_cash":1124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36215 SEL CATH PLC ARTERY ECH 1ST ORD-LT","code_information":[{"code":"3610314","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.0,"discounted_cash":994.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36215 SEL CATH PLC ARTERY ECH 1ST ORD-RT","code_information":[{"code":"3610315","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.0,"discounted_cash":994.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36215 SEL CATH PLC ARTERY ECH 1ST ORD-BLT","code_information":[{"code":"3610316","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1698.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36216 SEL CATH PLC ARTERY INITL 2ND ORD-LT","code_information":[{"code":"3610317","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":1691.0,"discounted_cash":1014.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36216 SEL CATH PLC ARTERY INITL 2ND ORD-RT","code_information":[{"code":"3610318","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":1691.0,"discounted_cash":1014.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36216 SEL CATH ARTERY INITL 2ND ORD THRO/BRAC-BLT","code_information":[{"code":"3610319","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":2279.0,"discounted_cash":1367.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36217 SEL CATH PLC ARTERY INITL 3RD ORD-LT","code_information":[{"code":"3610320","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":3152.0,"discounted_cash":1891.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36217 SEL CATH PLC ARTERY INITL 3RD ORD-RT","code_information":[{"code":"3610321","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":3152.0,"discounted_cash":1891.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36217 SEL CATH ARTERY INITL 3RD ORD THRO/BRAC-BLT","code_information":[{"code":"3610322","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":4673.0,"discounted_cash":2803.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36218 SEL CATH PLAC ARTERY ADD'L 2ND/3RD","code_information":[{"code":"3610323","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36218","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":262.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36245 SEL CATH PLC ARTERY EACH 1ST ORD-LT","code_information":[{"code":"3610324","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.0,"discounted_cash":1047.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36245 SEL CATH PLC ARTERY EACH 1ST ORD-RT","code_information":[{"code":"3610325","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.0,"discounted_cash":1047.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36245 SEL CATH PLC ARTERY EACH 1ST ORD-BLT","code_information":[{"code":"3610326","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":2614.0,"discounted_cash":1568.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36246 SEL CATH PLC ART INITIL 2ND ORD-LT","code_information":[{"code":"3610328","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":966.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36246 SEL CATH PLC ART INITIL 2ND ORD-RT","code_information":[{"code":"3610329","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1610.0,"discounted_cash":966.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36246 SEL CATH ART INT 2ND ORD ABD/PELVIS/LE-BLT","code_information":[{"code":"3610330","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":2416.0,"discounted_cash":1449.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36247 SEL CATH PLC ART INITIL 3RD ORD-LT","code_information":[{"code":"3610332","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2008.0,"discounted_cash":1204.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36247 SEL CATH PLC ART INITIL 3RD ORD-RT","code_information":[{"code":"3610333","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2008.0,"discounted_cash":1204.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36247 SEL CATH ART INT 3RD ORD ABD/PLV/LE-BLT","code_information":[{"code":"3610334","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":3011.0,"discounted_cash":1806.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36248 SEL CATH PLACE ART ADDL 2ND/3RD","code_information":[{"code":"3610336","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.0,"discounted_cash":516.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36470 PRO INJ SCLEROSCANT, SNGL VEIN, OTHR THN TELANGIECTASIA","code_information":[{"code":"3610338","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.0,"discounted_cash":1107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36471 INJ SCLEROSCANT, MULTI VEIN, OTHR THN TELANGIECTASIA, SAME LEG","code_information":[{"code":"3610339","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.0,"discounted_cash":1107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36475 ENDOVENOUS ABLATION INCOMPT VEIN,EXT 1ST","code_information":[{"code":"3610340","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36475","type":"HCPCS"}],"standard_charges":[{"gross_charge":11893.0,"discounted_cash":7135.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36476 ENDOVENOUS ABLATION INCOMPT VEIN,EXT 2+ SAME EXTRMTY","code_information":[{"code":"3610341","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36476","type":"HCPCS"}],"standard_charges":[{"gross_charge":5158.0,"discounted_cash":3094.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36478 ENDOVNS ABLATION INCOMPT VEIN,LASER 1ST","code_information":[{"code":"3610342","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36478","type":"HCPCS"}],"standard_charges":[{"gross_charge":9469.0,"discounted_cash":5681.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VENOUS CATH HC SEL ORGAN BLOOD SAMPLE","code_information":[{"code":"3610345","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2260.0,"discounted_cash":1356.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36555 INS NON-TUN CENTRL INSERT CENTRL VENOUS CATH <5YRS","code_information":[{"code":"3610347","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":4286.0,"discounted_cash":2571.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36556 CENTRAL LINE INSERTION AGE 5 YEARS OR OLDER","code_information":[{"code":"3610348","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3726.0,"discounted_cash":2235.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36557 INS TUNLD CENTRL INSERT CVC < 5YRS W/O PORT/PUMP","code_information":[{"code":"3610349","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36557","type":"HCPCS"}],"standard_charges":[{"gross_charge":10036.0,"discounted_cash":6021.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INS TUNLD CENTRL INSERT CVC >5YRS W/O PORT/PUMP (HEMO)","code_information":[{"code":"3610350","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":10036.0,"discounted_cash":6021.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36558 INS TUNLD CENTRL INSERT CVC >5YRS W/O PORT/PUMP","code_information":[{"code":"3610351","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":10036.0,"discounted_cash":6021.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36560 INS TUNLD CENTRL INSERT CVAD <5YRS W/SUBQ  PORT","code_information":[{"code":"3610352","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36560","type":"HCPCS"}],"standard_charges":[{"gross_charge":9773.0,"discounted_cash":5863.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36561 INS TUNLD CENTRL INSERT CVAD >5YRS W/SUBQ  PORT","code_information":[{"code":"3610353","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":11491.0,"discounted_cash":6894.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36568 PICC LINE INSERTION  W/O SUBQ PORT < 5YRS W/O IMAGING GUIDE","code_information":[{"code":"3610357","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":9068.0,"discounted_cash":5440.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36569 PICC LINE INSERTION W/O SUBQ PORT >5YRS W/O IMAGING GUIDE","code_information":[{"code":"3610360","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":6043.0,"discounted_cash":3625.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36575 REPAIR CVC W/O PORT/PUMP","code_information":[{"code":"3610365","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2766.0,"discounted_cash":1659.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36576 REPAIR CVAD W/ SUB Q PORT/PUMP","code_information":[{"code":"3610366","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36576","type":"HCPCS"}],"standard_charges":[{"gross_charge":4839.0,"discounted_cash":2903.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36580 RPL COMP, NON-TUN CI CVC SAME VAS W/O PORT/PUMP","code_information":[{"code":"3610368","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36580","type":"HCPCS"}],"standard_charges":[{"gross_charge":4227.0,"discounted_cash":2536.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36581 RPL COMP,TUNLD CI CVC SAME VAS W/O PORT/PUMP","code_information":[{"code":"3610369","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":11774.0,"discounted_cash":7064.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36582 RPL COMP,TUNLD CI CVC SAME VAS W/ PORT","code_information":[{"code":"3610370","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":10398.0,"discounted_cash":6238.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36585 RPL COMP, PICC SAME VAS W/SUB Q PORT","code_information":[{"code":"3610373","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36585","type":"HCPCS"}],"standard_charges":[{"gross_charge":7507.0,"discounted_cash":4504.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36589 REMV TUNLD CVC W/O SUB Q PORT OR PUMP","code_information":[{"code":"3610375","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":3450.0,"discounted_cash":2070.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36590 REMV TUNLD CVAD W/SUB Q PORT OR PUMP","code_information":[{"code":"3610376","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":3739.0,"discounted_cash":2243.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36593 DECLOT BY THROMBOLYTIC IMPLANTED VASC DEV/CATH","code_information":[{"code":"3610377","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1842.0,"discounted_cash":1105.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36596 MCH REM INTRLMNL OBST MTRL CVD PER LUMEN","code_information":[{"code":"3610379","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36596","type":"HCPCS"}],"standard_charges":[{"gross_charge":4989.0,"discounted_cash":2993.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36597 REPOSITION CENTRAL CATH W/FLUORO","code_information":[{"code":"3610380","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":4579.0,"discounted_cash":2747.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36598 INJ CONTRAST EVAL EXIST CVD INCL FLURO RT","code_information":[{"code":"3610382","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":538.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36620 ARTERIAL CATH SAMPLING/TRNSFSN,PERC","code_information":[{"code":"3610383","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":301.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37187 PERC TRNSLUMINAL VENOUS MECH THROMBOECTOMY","code_information":[{"code":"3610394","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":11911.0,"discounted_cash":7146.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37188 PERC VENOUS MECH THROMBOECTOMY REPEAT TX","code_information":[{"code":"3610395","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37188","type":"HCPCS"}],"standard_charges":[{"gross_charge":9438.0,"discounted_cash":5662.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THROMBLYSIS CEREBRAL,INTRAVENOUS INFUSION","code_information":[{"code":"3610396","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":923.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37200 TRANSCATHETER BIOPSY","code_information":[{"code":"3610397","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37200","type":"HCPCS"}],"standard_charges":[{"gross_charge":12703.0,"discounted_cash":7621.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37799 UNLISTED PROCEDURE,VASCULAR SURGERY","code_information":[{"code":"3610415","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":3788.0,"discounted_cash":2272.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38220 DIAGNOSTIC BONE MARROW; ASPIRATION","code_information":[{"code":"3610416","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1831.0,"discounted_cash":1098.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38221 DIAGNOSTIC BONE MARROW; BIOPSY","code_information":[{"code":"3610417","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1990.0,"discounted_cash":1194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BX/EXC LYMPH NODE NDL SUPRFCL-LT","code_information":[{"code":"3610418","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":1503.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BX/EXC LYMPH NODE NDL SUPRFCL-RT","code_information":[{"code":"3610419","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":1503.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BX/EXC LYMPH NODE NDL SUPRFCL-BLT","code_information":[{"code":"3610420","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3757.0,"discounted_cash":2254.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC BIOPSY LYMP, OPN, DEEP AXIL NODES-LT","code_information":[{"code":"3610421","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38525","type":"HCPCS"}],"standard_charges":[{"gross_charge":6142.0,"discounted_cash":3685.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BIOPSY LYMP, OPN, DEEP AXIL NODES-RT","code_information":[{"code":"3610422","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38525","type":"HCPCS"}],"standard_charges":[{"gross_charge":6142.0,"discounted_cash":3685.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BIOPSY LYMP, OPN, DEEP AXIL NODES-BLT","code_information":[{"code":"3610423","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38525","type":"HCPCS"}],"standard_charges":[{"gross_charge":9213.0,"discounted_cash":5527.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 38792 INJ PROC RADIOACT TRACR ID SENT NODE-RT","code_information":[{"code":"3610424","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 38792 INJ PROC RADIOACT TRACR ID SENT NODE-LT","code_information":[{"code":"3610425","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 38792 INJ PROC RADIOACT TRACR ID SENT NODE-BLT","code_information":[{"code":"3610426","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":568.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 42400 BIOPSY, SALIVARY GLAND","code_information":[{"code":"3610427","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":4158.0,"discounted_cash":2494.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42550 INJECT PRO SIALOGRAM","code_information":[{"code":"3610428","type":"CDM"},{"code":"0320","type":"RC"},{"code":"42550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.0,"discounted_cash":790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ESOPH W TRANSENDOSCOPIC, BALLOON DILAT (<30 MM)","code_information":[{"code":"3610431","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3473.0,"discounted_cash":2083.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43752 NASO/ORO TUBE PLACEMENT","code_information":[{"code":"3610435","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":905.0,"discounted_cash":543.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43761 REPOSITONING GASTRIC FEED TUBE","code_information":[{"code":"3610437","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":3803.0,"discounted_cash":2281.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TUBE/NDLE CATH JEJUNO ENTERAL ALIMENT, INTRAOP","code_information":[{"code":"3610439","type":"CDM"},{"code":"0361","type":"RC"},{"code":"44015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SM INTES ENDOS, PLC HC PERC JEJU TUBE","code_information":[{"code":"3610441","type":"CDM"},{"code":"0361","type":"RC"},{"code":"44372","type":"HCPCS"}],"standard_charges":[{"gross_charge":5221.0,"discounted_cash":3132.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 44500 INTRO  PROC - LONG GI TUBE","code_information":[{"code":"3610442","type":"CDM"},{"code":"0361","type":"RC"},{"code":"44500","type":"HCPCS"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1339.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47000 PERC NEEDLE BIOPSY LIVER","code_information":[{"code":"3610448","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2968.0,"discounted_cash":1780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HEPATOTOMY HC OPENDRAIN","code_information":[{"code":"3610450","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"discounted_cash":945.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47490 PERC CHOLECYSTOSTOMY","code_information":[{"code":"3610456","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":4595.0,"discounted_cash":2757.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC BILIARY ENDOSCOPY VIA T-TUBE WITH DIL W/O STENT","code_information":[{"code":"3610465","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47555","type":"HCPCS"}],"standard_charges":[{"gross_charge":5850.0,"discounted_cash":3510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47556 PERC BILIARY ENDOSCOPY VIA T-TUBE WITH DIL W STENT","code_information":[{"code":"3610466","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47556","type":"HCPCS"}],"standard_charges":[{"gross_charge":9615.0,"discounted_cash":5769.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 48102 PERC BIOPSY PANCREAS  NEEDLE","code_information":[{"code":"3610470","type":"CDM"},{"code":"0361","type":"RC"},{"code":"48102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.0,"discounted_cash":1010.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPENDRAIN PERITONEAL ABSCESS","code_information":[{"code":"3610473","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"discounted_cash":945.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPENDRAIN RETROPERITONEAL ABSCESS","code_information":[{"code":"3610476","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"discounted_cash":945.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49180 BIOPSY ABD/RETROPERITONL MASS HC PERC NEEDLE","code_information":[{"code":"3610481","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":2689.0,"discounted_cash":1613.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49419 INSERT INTRAPERITONEAL CATH W SUB Q RESERVIOR-PERM","code_information":[{"code":"3610483","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49419","type":"HCPCS"}],"standard_charges":[{"gross_charge":13433.0,"discounted_cash":8059.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49421 INS INTRAPERITONEAL CANULA/CATH DRAIN/DIALYSIS  PERM","code_information":[{"code":"3610485","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49421","type":"HCPCS"}],"standard_charges":[{"gross_charge":10218.0,"discounted_cash":6130.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49422 REMOVAL PERMANENT INTRAPERITONEAL CATHETER","code_information":[{"code":"3610486","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49422","type":"HCPCS"}],"standard_charges":[{"gross_charge":4371.0,"discounted_cash":2622.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49423 EXCHANGE PREVIOUS PLACED ABSCE/CYST DRAIN CATHTR","code_information":[{"code":"3610487","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":3634.0,"discounted_cash":2180.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49424 INJ CONTRAST ASSESS ABS/CYST VIA CATH","code_information":[{"code":"3610488","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49424","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1003.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49440 PERC INSERT GASTRO TUBE W/FLURO INC CONTRST","code_information":[{"code":"3610491","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":4847.0,"discounted_cash":2908.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49441 PERC INSERT DUOD/JEJUNO TUBE W/FLURO INC CONTR","code_information":[{"code":"3610492","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49441","type":"HCPCS"}],"standard_charges":[{"gross_charge":3321.0,"discounted_cash":1992.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49446 PERC CONVRT GASTRO TO GAST-JEJUN W/FLURO/CONTRAST","code_information":[{"code":"3610494","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49446","type":"HCPCS"}],"standard_charges":[{"gross_charge":4587.0,"discounted_cash":2752.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49450 PERC REPLC GASTRO/CECO TUBE  W/FLURO/CONTR","code_information":[{"code":"3610495","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":3443.0,"discounted_cash":2065.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49451 PERC REPLC DUOD/JEJUN TB  W/FLURO/CONTRST","code_information":[{"code":"3610496","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2797.0,"discounted_cash":1678.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49452 PERC REPLC GASTR/JEJUN TB  W/FLURO/CONSTR","code_information":[{"code":"3610497","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":1173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49465 PERC CNTRST HC INJ RAD EVAL GS/DUOD/JE/CECO","code_information":[{"code":"3610499","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.0,"discounted_cash":340.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49999 UNLISTEDPROC-ABDOM/PERINEUM/OMEN","code_information":[{"code":"3610500","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49999","type":"HCPCS"}],"standard_charges":[{"gross_charge":6147.0,"discounted_cash":3688.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 50200 PERC RENAL BIOPSY  TRC/NEEDLE-LT","code_information":[{"code":"3610503","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2739.0,"discounted_cash":1643.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50200 PERC RENAL BIOPSY  TRC/NEEDLE-RT","code_information":[{"code":"3610504","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2739.0,"discounted_cash":1643.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50200 PERC RENAL BIOPSY  TRC/NEEDLE-BLT","code_information":[{"code":"3610505","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3736.0,"discounted_cash":2241.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50382 PERC REM/REP ID URTRL STENT,  RS&I-LT","code_information":[{"code":"3610506","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":12112.0,"discounted_cash":7267.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50382 PERC REM/REP ID URTRL STENT,  RS&I-RT","code_information":[{"code":"3610507","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":12112.0,"discounted_cash":7267.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50382 PERC REM/REP ID URTRL STENT,  RS&I-BIL","code_information":[{"code":"3610508","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":17170.0,"discounted_cash":10302.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50384 PERC REM ID URETERAL STENT , RS&I - LT","code_information":[{"code":"3610509","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50384","type":"HCPCS"}],"standard_charges":[{"gross_charge":9632.0,"discounted_cash":5779.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50384 PERC REM ID URETERAL STENT , RS&I - RT","code_information":[{"code":"3610510","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50384","type":"HCPCS"}],"standard_charges":[{"gross_charge":9632.0,"discounted_cash":5779.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50384 PERC REM ID URETERAL STENT , RS&I - BLT","code_information":[{"code":"3610511","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50384","type":"HCPCS"}],"standard_charges":[{"gross_charge":14445.0,"discounted_cash":8667.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC REM/REP EXTRNL URTRL STENT W/FLURO RS&LT","code_information":[{"code":"3610514","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":8056.0,"discounted_cash":4833.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REM/REP EXTRNL URTRL STENT W/FLURO RS&RT","code_information":[{"code":"3610515","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":8056.0,"discounted_cash":4833.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REM/REP EXTRNL URTRL STNT W/FLURO RS&BLT","code_information":[{"code":"3610516","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50387","type":"HCPCS"}],"standard_charges":[{"gross_charge":12074.0,"discounted_cash":7244.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50389 REM NEPHRO TUBE W/FLURO W/ID STENT-LT","code_information":[{"code":"3610517","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":2065.0,"discounted_cash":1239.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50389 REM NEPHRO TUBE W/FLURO W/ID STENT-RT","code_information":[{"code":"3610518","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":2065.0,"discounted_cash":1239.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50389 REM NEPHRO TUBE W/FLURO W/ID STENT-BLT","code_information":[{"code":"3610519","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":3100.0,"discounted_cash":1860.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50390 PERC ASP/HC INJ RENAL CYST/PELVIS -LT","code_information":[{"code":"3610520","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":5175.0,"discounted_cash":3105.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50390 PERC ASP/HC INJ RENAL CYST/PELVIS -RT","code_information":[{"code":"3610521","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50390","type":"HCPCS"}],"standard_charges":[{"gross_charge":5175.0,"discounted_cash":3105.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50592 PERC ABLATION,1/MORE RENAL TUMOR,RADIOFREQ-LT","code_information":[{"code":"3610537","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50592","type":"HCPCS"}],"standard_charges":[{"gross_charge":12486.0,"discounted_cash":7491.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50593 PERC ABLATON, RENAL TUMOR,UNLAT  CRYO-LT","code_information":[{"code":"3610540","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":15298.0,"discounted_cash":9178.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50593 PERC ABLATON, RENAL TUMOR,UNLAT CRYO-RT","code_information":[{"code":"3610541","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":15298.0,"discounted_cash":9178.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50593 PERC ABLATON, RENAL TUMOR,UNLAT  CRYO-BLT","code_information":[{"code":"3610542","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":20953.0,"discounted_cash":12571.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50684 INJ PROC-VIA URETERAL CATHETER RT","code_information":[{"code":"3610543","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50684","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":488.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50688 CHANGE OF URETEROSTOMY TUBE","code_information":[{"code":"3610544","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50688","type":"HCPCS"}],"standard_charges":[{"gross_charge":6644.0,"discounted_cash":3986.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 50690 INJ PROC-VISUAL ILIEAL CONDUIT/URETEROPYL","code_information":[{"code":"3610545","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50690","type":"HCPCS"}],"standard_charges":[{"gross_charge":665.0,"discounted_cash":399.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51600 INJ PROC CYSTO/VOID URETHCYSTOGRHY","code_information":[{"code":"3610547","type":"CDM"},{"code":"0320","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":883.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51610 INJ RETROGRADE URETHROCYSTOGRAPHY","code_information":[{"code":"3610548","type":"CDM"},{"code":"0320","type":"RC"},{"code":"51610","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.0,"discounted_cash":1345.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51700 BLADDER IRRIGATION SIMPLE LAVAGE INSTILL","code_information":[{"code":"3610549","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1171.0,"discounted_cash":702.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT NON-INDWELLING BLADDER CATH","code_information":[{"code":"3610550","type":"CDM"},{"code":"0761","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51702 INSERT TEMP INDEWEL BLADDER CATH SIMPLE","code_information":[{"code":"3610551","type":"CDM"},{"code":"0761","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51705 CYSTOSTOMY TUBE CHANGE, SIMPLE","code_information":[{"code":"3610553","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":506.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROC-URINARY (CT)","code_information":[{"code":"3610555","type":"CDM"},{"code":"0361","type":"RC"},{"code":"53899","type":"HCPCS"}],"standard_charges":[{"gross_charge":3297.0,"discounted_cash":1978.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 55875 TRANSPERINEAL NEEDLE/CATH PLACE, PROSTATE","code_information":[{"code":"3610561","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55875","type":"HCPCS"}],"standard_charges":[{"gross_charge":12638.0,"discounted_cash":7582.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLC INTRST DVCE RT GUIDE,PROST,SNG/MLT","code_information":[{"code":"3610562","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3251.0,"discounted_cash":1950.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIOPSY VULVA/PERINEUM-1ST LES","code_information":[{"code":"3610566","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1829.0,"discounted_cash":1097.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERTION PESSARY DEVICE","code_information":[{"code":"3610570","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 58340 INJECT SALINE/CONTRAST SIS OR HYSTSALPINGOGRAPHY","code_information":[{"code":"3610581","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1198.0,"discounted_cash":718.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INT PRO FALLOPIAN TUBE CATH-LT","code_information":[{"code":"3610582","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58345","type":"HCPCS"}],"standard_charges":[{"gross_charge":6089.0,"discounted_cash":3653.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INT PRO FALLOPIAN TUBE CATH-RT","code_information":[{"code":"3610583","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58345","type":"HCPCS"}],"standard_charges":[{"gross_charge":6089.0,"discounted_cash":3653.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INT PRO FALLOPIAN TUBE CATH-BLT","code_information":[{"code":"3610584","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58345","type":"HCPCS"}],"standard_charges":[{"gross_charge":9136.0,"discounted_cash":5481.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC AMNIOCENTESIS DIAG - (RAD)","code_information":[{"code":"3610586","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1528.0,"discounted_cash":916.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 60100 PERC BIOPSY THYROID CORE NEEDLE","code_information":[{"code":"3610587","type":"CDM"},{"code":"0361","type":"RC"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2582.0,"discounted_cash":1549.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 60300 ASPIRATION/INJECT, THYROID CYST","code_information":[{"code":"3610588","type":"CDM"},{"code":"0361","type":"RC"},{"code":"60300","type":"HCPCS"}],"standard_charges":[{"gross_charge":3309.0,"discounted_cash":1985.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTEDPROCEDURE, ENDOCRINE SYS","code_information":[{"code":"3610589","type":"CDM"},{"code":"0361","type":"RC"},{"code":"60699","type":"HCPCS"}],"standard_charges":[{"gross_charge":7323.0,"discounted_cash":4393.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 61055 INJ CISTERNL/LAT C1-C2 PUNCTURE","code_information":[{"code":"3610591","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.0,"discounted_cash":828.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 61070 VP RESERVOIR TAP FOR ASPIRATION OR INJECTION","code_information":[{"code":"3610592","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2404.0,"discounted_cash":1442.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ENDOVASC TEMP BALLOON-HEAD/NECK","code_information":[{"code":"3610596","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61623","type":"HCPCS"}],"standard_charges":[{"gross_charge":20469.0,"discounted_cash":12281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 61624 PERC TRANSCATH OCC OR EMBOL,  CNS","code_information":[{"code":"3610597","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61624","type":"HCPCS"}],"standard_charges":[{"gross_charge":19272.0,"discounted_cash":11563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 61626 PERC TRNSCATH OCC/EMB NON CNS,HEAD/NCK","code_information":[{"code":"3610598","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61626","type":"HCPCS"}],"standard_charges":[{"gross_charge":12636.0,"discounted_cash":7581.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC BALLOON ANGIOPLASTY, INTRACRANIEL,","code_information":[{"code":"3610599","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61630","type":"HCPCS"}],"standard_charges":[{"gross_charge":4708.0,"discounted_cash":2824.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCATH PLC INTRAVASCLR STENT,INTRACRA","code_information":[{"code":"3610600","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61635","type":"HCPCS"}],"standard_charges":[{"gross_charge":14490.0,"discounted_cash":8694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC BALLOON DILTATION IC VASOSPASM 1ST VESL","code_information":[{"code":"3610601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61640","type":"HCPCS"}],"standard_charges":[{"gross_charge":4708.0,"discounted_cash":2824.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 61641 PERC BALLOON DIL IC SAME VAC TERRITORY-EA ADD'L","code_information":[{"code":"3610602","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61641","type":"HCPCS"}],"standard_charges":[{"gross_charge":4708.0,"discounted_cash":2824.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 61642 PERC BALLOON DIL IC  DIF VASC TERRITORY-EA ADD'L","code_information":[{"code":"3610603","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61642","type":"HCPCS"}],"standard_charges":[{"gross_charge":4708.0,"discounted_cash":2824.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62267 PERC ASP NP DISC/TISSUE FOR DIAGNOSIS","code_information":[{"code":"3610607","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62267","type":"HCPCS"}],"standard_charges":[{"gross_charge":3065.0,"discounted_cash":1839.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC ASP SPINAL CORD CYST/SYR","code_information":[{"code":"3610608","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62268","type":"HCPCS"}],"standard_charges":[{"gross_charge":2114.0,"discounted_cash":1268.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62270 LUMBAR PUNCTURE, DIAGNOSTIC","code_information":[{"code":"3610610","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2060.0,"discounted_cash":1236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62272 LUMBAR PUNCTURE FOR DRAINAGE","code_information":[{"code":"3610611","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2215.0,"discounted_cash":1329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62273 INJ EPIDURAL,BLOOD/CLOT PATCH","code_information":[{"code":"3610612","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3203.0,"discounted_cash":1921.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62284 INJ SPINE MYELOGRAPHY/CT (NON C1-C2)","code_information":[{"code":"3610613","type":"CDM"},{"code":"0320","type":"RC"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1736.0,"discounted_cash":1041.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62290 INJ PRO DISKOGRAPHY EA LEVEL LUMBAR","code_information":[{"code":"3610615","type":"CDM"},{"code":"0320","type":"RC"},{"code":"62290","type":"HCPCS"}],"standard_charges":[{"gross_charge":4042.0,"discounted_cash":2425.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ  DISKOGRAPHY EA LVL, CERVICAL OR THORACIC","code_information":[{"code":"3610616","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3197.0,"discounted_cash":1918.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64479 INJ ANES/STERD TRNSFORAMINAL CER/ THR SG LEVEL","code_information":[{"code":"3610633","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3948.0,"discounted_cash":2368.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64480 INJ ANES/STERD TRNSFORAMINAL CER/THR EA ADD'L LEVEL","code_information":[{"code":"3610634","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2264.0,"discounted_cash":1358.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64483 INJ ANES/STERD TRNSFORAMINAL LUM/SAC SGL LEVEL","code_information":[{"code":"3610635","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.0,"discounted_cash":1951.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64484 INJ ANES/STERD TRNSFORAMINAL LUM/SAC EA ADD'L LEVEL","code_information":[{"code":"3610636","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":994.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64680 DEST NEURO AGENT CELIAC PLEXUS,W/WO RAD","code_information":[{"code":"3610643","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64680","type":"HCPCS"}],"standard_charges":[{"gross_charge":2389.0,"discounted_cash":1433.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64999 UNLISTEDPROC-NERVOUS SYSTEM","code_information":[{"code":"3610645","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2514.0,"discounted_cash":1508.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96450 CHEMOTHERAPY ADMINISTER-CNS","code_information":[{"code":"3610663","type":"CDM"},{"code":"0361","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BX SOFT TISSUE  PELVIS/HIP DEEP","code_information":[{"code":"3610664","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27041","type":"HCPCS"}],"standard_charges":[{"gross_charge":6483.0,"discounted_cash":3889.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ESOPHAGEAL MOTILITY STUDY","code_information":[{"code":"3610665","type":"CDM"},{"code":"0750","type":"RC"},{"code":"91010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2042.0,"discounted_cash":1225.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES BRACHIPLEXUS CON'T INF BY CATH","code_information":[{"code":"3610667","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64416","type":"HCPCS"}],"standard_charges":[{"gross_charge":3152.0,"discounted_cash":1891.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES SCIATIC NERVE CON'T INF BY CATH","code_information":[{"code":"3610668","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64446","type":"HCPCS"}],"standard_charges":[{"gross_charge":2780.0,"discounted_cash":1668.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ ANES FEMORAL NERVE CON'T INF BY CATH","code_information":[{"code":"3610669","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64448","type":"HCPCS"}],"standard_charges":[{"gross_charge":4203.0,"discounted_cash":2521.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANES LUMBAR PLEXUS CON'T INF BY CATH","code_information":[{"code":"3610670","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64449","type":"HCPCS"}],"standard_charges":[{"gross_charge":3152.0,"discounted_cash":1891.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ESOPH/GASTRIC REFLUX TEST WITH PH","code_information":[{"code":"3610672","type":"CDM"},{"code":"0361","type":"RC"},{"code":"91034","type":"HCPCS"}],"standard_charges":[{"gross_charge":4191.0,"discounted_cash":2514.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CREATE PERICARDIAL WINDOW DRAINAGE","code_information":[{"code":"3610673","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33025","type":"HCPCS"}],"standard_charges":[{"gross_charge":4124.0,"discounted_cash":2474.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31575 LARYNGOSCOPY, FLEXIBLE, DIAGNOSTIC","code_information":[{"code":"3610675","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.0,"discounted_cash":607.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIOPSY MUSCLE, SUPERFICIAL","code_information":[{"code":"3610676","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20200","type":"HCPCS"}],"standard_charges":[{"gross_charge":6194.0,"discounted_cash":3716.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ORTHO APPL SHORT LEG CAST WALKING TYPE RT","code_information":[{"code":"3610678","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL SHORT LEG CAST WALKING TYPE LT","code_information":[{"code":"3610679","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, KNEE RT","code_information":[{"code":"3610680","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":364.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, KNEE LT","code_information":[{"code":"3610681","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":364.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, ANKLE RT","code_information":[{"code":"3610682","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, ANKLE LT","code_information":[{"code":"3610683","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, SHOULDER RT","code_information":[{"code":"3610684","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, SHOULDER LT","code_information":[{"code":"3610685","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, ELBOW OR WRIST RT","code_information":[{"code":"3610686","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, ELBOW OR WRIST LT","code_information":[{"code":"3610687","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, HAND OR FINGER RT","code_information":[{"code":"3610688","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO STRAPPING, HAND OR FINGER LT","code_information":[{"code":"3610689","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29505 ORTHO APPL LONG LEG SPLINT RT","code_information":[{"code":"3610690","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29505 ORTHO APPL LONG LEG SPLINT LT","code_information":[{"code":"3610691","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29515 ORTHO APPL SHORT LEG SPLINT (CALF/FOOT) RT","code_information":[{"code":"3610692","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29515 ORTHO APPL SHORT LEG SPLINT (CALF/FOOT) LT","code_information":[{"code":"3610693","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29515 ORTHO APPL SHORT LEG SPLINT (CALF/FOOT) BLT","code_information":[{"code":"3610694","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.0,"discounted_cash":454.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29105 ORTHO APPL LONG ARM SPLINT RT","code_information":[{"code":"3610695","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29105 ORTHO APPL LONG ARM SPLINT LT","code_information":[{"code":"3610696","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 ORTHO APPL SHORT ARM SPLINT, STATIC RT","code_information":[{"code":"3610697","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 ORTHO APPL SHORT ARM SPLINT, STATIC LT","code_information":[{"code":"3610698","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 ORTHO APPL SHORT ARM SPLINT, STATIC BLT","code_information":[{"code":"3610699","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":757.0,"discounted_cash":454.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC ORTHO APPL CAST SHOULDER TO HAND RT","code_information":[{"code":"3610700","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL CAST SHOULDER TO HAND LT","code_information":[{"code":"3610701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL CAST ELBOW TO FINGER RT","code_information":[{"code":"3610702","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL CAST ELBOW TO FINGER LT","code_information":[{"code":"3610703","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL CAST HAND/FORARM (GUANTLET) RT","code_information":[{"code":"3610704","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL CAST HAND/FORARM (GUANTLET) LT","code_information":[{"code":"3610705","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL LONG LEG CAST (THIGH TO TOES) RT","code_information":[{"code":"3610706","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL LONG LEG CAST (THIGH TO TOES) LT","code_information":[{"code":"3610707","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL SHORT LEG CAST (BELOW KNEE) RT","code_information":[{"code":"3610708","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL SHORT LEG CAST (BELOW KNEE) LT","code_information":[{"code":"3610709","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL OF HIP SPICA CAST ONE LEG -RT","code_information":[{"code":"3610710","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL OF HIP SPICA CAST ONE LEG -LT","code_information":[{"code":"3610711","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL OF HIP SPICA CAST BOTH LEGS","code_information":[{"code":"3610712","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29325","type":"HCPCS"}],"standard_charges":[{"gross_charge":1910.0,"discounted_cash":1146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ORTHO APPL OF CYLINDER CAST (THIGH TO ANKLE)RT","code_information":[{"code":"3610713","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ORTHO APPL OF CYLINDER CAST (THIGH TO ANKLE) LT","code_information":[{"code":"3610714","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 11044 DEBRIDE TISSUE/MUSCLE/BONE","code_information":[{"code":"3610715","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3876.0,"discounted_cash":2325.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29705 REMOVE/BIVALVE FULL ARM/LEG CAST RT","code_information":[{"code":"3610716","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29705 REMOVE/BIVALVE FULL ARM/LEG CAST LT","code_information":[{"code":"3610717","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29705 REMOVE/BIVALVE FULL ARM/LEG CAST BIL","code_information":[{"code":"3610718","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":521.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC TRANSCUTANS O2 TENSN MON, SNG LEV BLT","code_information":[{"code":"3610721","type":"CDM"},{"code":"0920","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":559.0,"discounted_cash":335.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCUTANEOUS O2 TENSION MON COMP BLT","code_information":[{"code":"3610722","type":"CDM"},{"code":"0920","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1022.0,"discounted_cash":613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BEHAV CHNG SMOKING 3-10 MIN WC","code_information":[{"code":"3610723","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36598 INJ CONTRAST  EVAL EXIST CVD INCL FLURO LT","code_information":[{"code":"3610724","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":538.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36598 INJ CONTRAST  EVAL EXIST CVD INCL FLURO BIL","code_information":[{"code":"3610725","type":"CDM"},{"code":"0320","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.0,"discounted_cash":807.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50684 INJ PROC-VIA URETERAL CATHETER LT","code_information":[{"code":"3610726","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50684","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":488.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50684 INJ PROC-VIA URETERAL CATHETER BIL","code_information":[{"code":"3610727","type":"CDM"},{"code":"0320","type":"RC"},{"code":"50684","type":"HCPCS"}],"standard_charges":[{"gross_charge":1219.0,"discounted_cash":731.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PINCH GRAFT, SGL,MULT UP TO 2CM","code_information":[{"code":"3610734","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15050","type":"HCPCS"}],"standard_charges":[{"gross_charge":2320.0,"discounted_cash":1392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCHOSCOPY W/FLURO W/COMPUTER ASSIST","code_information":[{"code":"3610738","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31627","type":"HCPCS"}],"standard_charges":[{"gross_charge":4399.0,"discounted_cash":2639.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32552 REM INDEWLL TUNNELED PLEURAL CATH W/CUFF","code_information":[{"code":"3610739","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.0,"discounted_cash":1445.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32561 INSTIL VIA CHEST TUBE/CATH INITIAL DAY","code_information":[{"code":"3610741","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32561","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":1818.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSTIL VIA CHEST TUBE/CATH SUBSQ DAY","code_information":[{"code":"3610742","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32562","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":1818.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64490 INJ DX/THER AGENT CERVICAL/THORACIC RT","code_information":[{"code":"3610744","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3911.0,"discounted_cash":2346.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64490 INJ DX/THER AGENT CERVICAL/THORACIC LT","code_information":[{"code":"3610745","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3911.0,"discounted_cash":2346.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64490 INJ DX/THER AGENT CERVICAL/THORACIC BLT","code_information":[{"code":"3610746","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":5862.0,"discounted_cash":3517.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64491 INJ DX/THER AGNT CERV/THOR 2ND LEVEL- RT","code_information":[{"code":"3610747","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":838.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64491 INJ DX/THER AGNT CERV/THOR 2ND LEVEL-LT","code_information":[{"code":"3610748","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":838.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64491 INJ DX/THER AGNT CERV/THOR 2ND LEVEL-BLT","code_information":[{"code":"3610749","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2093.0,"discounted_cash":1255.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64492 INJ DX/THER AGNT CERV/THOR 3RD LEVEL - RT","code_information":[{"code":"3610750","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1296.0,"discounted_cash":777.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64492 INJ DX/THER AGNT CERV/THOR 3RD LEVEL - LT","code_information":[{"code":"3610751","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1296.0,"discounted_cash":777.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64492 INJ DX/THER AGNT CERV/THOR 3RD LEVEL - BLT","code_information":[{"code":"3610752","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":2201.0,"discounted_cash":1320.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64493 INJ DX/THER AGNT LUM/SCRL SNG LEVEL RT","code_information":[{"code":"3610753","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":3399.0,"discounted_cash":2039.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64493 INJ DX/THER AGNT LUM/SCRL SNG LEVEL LT","code_information":[{"code":"3610754","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":3399.0,"discounted_cash":2039.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64493 INJ DX/THER AGNT LUM/SCRL SNG LEVEL BLT","code_information":[{"code":"3610755","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":5098.0,"discounted_cash":3058.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64494 INJ DX/THER AGNT LUM/SCRL 2ND LEVEL RT","code_information":[{"code":"3610756","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.0,"discounted_cash":730.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64494 INJ DX/THER AGNT LUM/SCRL 2ND LEVEL-LT","code_information":[{"code":"3610757","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1217.0,"discounted_cash":730.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64494 INJ DX/THER AGNT LUM/SCRL 2ND LEVEL BLT","code_information":[{"code":"3610758","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1091.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC INJ DX/THER AGNT LUM/SCRL 3RD LEVEL RT","code_information":[{"code":"3610759","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1091.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INJ DX/THER AGNT LUM/SCRL 3RD LEVEL LT","code_information":[{"code":"3610760","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1091.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INJ DX/THER AGNT LUM/SCRL 3RD LEVEL BLT","code_information":[{"code":"3610761","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":3095.0,"discounted_cash":1857.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 75746 PULMONARY-NON-SELECTIVE CATH/VENOUS INJ","code_information":[{"code":"3610762","type":"CDM"},{"code":"0361","type":"RC"},{"code":"75746","type":"HCPCS"}],"standard_charges":[{"gross_charge":3355.0,"discounted_cash":2013.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WOUND DEBRIDEMENT NON-SELECTIVE","code_information":[{"code":"3610763","type":"CDM"},{"code":"0361","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":336.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRACH TUBE CHGE(PRIOR EST FIST TRK)","code_information":[{"code":"3610767","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51102 ASPIRATION BLADDER W/INSERT SUPRPB CATH","code_information":[{"code":"3610782","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":14629.0,"discounted_cash":8777.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INS CERV DILATOR(LAMINARIA PROSTAGL)","code_information":[{"code":"3610787","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59200","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.0,"discounted_cash":502.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CYSTO W/INS WIRE KIDNY,PERC NEPH","code_information":[{"code":"3610788","type":"CDM"},{"code":"0361","type":"RC"},{"code":"52334","type":"HCPCS"}],"standard_charges":[{"gross_charge":9738.0,"discounted_cash":5842.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IMP/REV TUNNELED CATH PUMP W/O LAMI","code_information":[{"code":"3610789","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62350","type":"HCPCS"}],"standard_charges":[{"gross_charge":10981.0,"discounted_cash":6588.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPOS PREVIOUS IMP PACER/DEFIB&/OR LEAD","code_information":[{"code":"3610790","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":8260.0,"discounted_cash":4956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT ELECTRODE FOR LV PACE TO PACER","code_information":[{"code":"3610791","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33224","type":"HCPCS"}],"standard_charges":[{"gross_charge":51544.0,"discounted_cash":30926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT ELECTRODE TO NEW CARDIO-DEFIB","code_information":[{"code":"3610792","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":51544.0,"discounted_cash":30926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPOS PREVIOUS IMPLANTED ELECTRODE","code_information":[{"code":"3610793","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33226","type":"HCPCS"}],"standard_charges":[{"gross_charge":4885.0,"discounted_cash":2931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HARVEST SKIN FOR AUTOGRAFT 100SQ CM OR <","code_information":[{"code":"3610803","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15040","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.0,"discounted_cash":555.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLIT THICK AUTOGRAFT 1ST 100SQ CM","code_information":[{"code":"3610804","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":12208.0,"discounted_cash":7324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLIT THICK AUTOGRAFT EA ADD 100 SQ CM","code_information":[{"code":"3610805","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15101","type":"HCPCS"}],"standard_charges":[{"gross_charge":12208.0,"discounted_cash":7324.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLIT THICK AUTOGRAFT HEAD 1ST 100 SQ CM","code_information":[{"code":"3610806","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":7556.0,"discounted_cash":4533.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLIT THICK AUTOGRAFT HEAD EA ADD 100SQ CM","code_information":[{"code":"3610807","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15121","type":"HCPCS"}],"standard_charges":[{"gross_charge":7556.0,"discounted_cash":4533.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FULL THICKNESS GRAFT 20 SQ CM OR <","code_information":[{"code":"3610808","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5072.0,"discounted_cash":3043.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FULL THICK GRAFT INC CLOS DNR SITE 20SQ CM <","code_information":[{"code":"3610810","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":3742.0,"discounted_cash":2245.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIOPSY SOFT TISS THIGH/KNEE; SUPERFICIAL-LT","code_information":[{"code":"3610821","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":4189.0,"discounted_cash":2513.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BIOPSY SOFT TISS THIGH/KNEE; SUPERFICIAL-RT","code_information":[{"code":"3610822","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":4189.0,"discounted_cash":2513.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BIOPSY SOFT TISS THIGH/KNEE; SUPERFICIAL-BLT","code_information":[{"code":"3610823","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27323","type":"HCPCS"}],"standard_charges":[{"gross_charge":6284.0,"discounted_cash":3770.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC ATHERECTOMY INC RAD S & I RENAL ARTERY","code_information":[{"code":"3610868","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0234T","type":"HCPCS"}],"standard_charges":[{"gross_charge":23398.0,"discounted_cash":14038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0235T ATHERECTOMY INC RAD S & I VISCERAL ARTERY","code_information":[{"code":"3610869","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0235T","type":"HCPCS"}],"standard_charges":[{"gross_charge":23398.0,"discounted_cash":14038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ATHERECTOMY INC RAD S & I ABD AORTA","code_information":[{"code":"3610870","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0236T","type":"HCPCS"}],"standard_charges":[{"gross_charge":23398.0,"discounted_cash":14038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ATHERECTOMY INC RAD S & I BRACHIOCEPHALIC EA","code_information":[{"code":"3610871","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0237T","type":"HCPCS"}],"standard_charges":[{"gross_charge":24636.0,"discounted_cash":14781.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0238T ATHERECTOMY INC RAD S & I ILIAC ART EA","code_information":[{"code":"3610872","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"gross_charge":22887.0,"discounted_cash":13732.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCH W BALLOON OCCLUSION/ADMIN OCCLSV SUB","code_information":[{"code":"3610873","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31634","type":"HCPCS"}],"standard_charges":[{"gross_charge":6943.0,"discounted_cash":4165.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49418 INSERTION OF TUNNELED INTRAPERITONEAL CATHETER","code_information":[{"code":"3610874","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":15165.0,"discounted_cash":9099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRMT SPFC WOUND DEHIS SIMPLE CLOS","code_information":[{"code":"3610880","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2614.0,"discounted_cash":1568.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TENOTOMY OPEN EXTENSOR FOOT OR TOE EA TENDON","code_information":[{"code":"3610885","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28234","type":"HCPCS"}],"standard_charges":[{"gross_charge":9374.0,"discounted_cash":5624.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21920 BIOPSY SOFT TISSUE BACK OR FLANK SUPERFICIAL","code_information":[{"code":"3610887","type":"CDM"},{"code":"0361","type":"RC"},{"code":"21920","type":"HCPCS"}],"standard_charges":[{"gross_charge":4408.0,"discounted_cash":2644.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20526 INJ THERAPEUTIC CARPAL TUNNEL-RT","code_information":[{"code":"3610891","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.0,"discounted_cash":837.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20526 INJ THERAPEUTIC CARPAL TUNNEL-LT","code_information":[{"code":"3610892","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.0,"discounted_cash":837.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20526 INJ THERAPEUTIC CARPAL TUNNEL-BLT","code_information":[{"code":"3610893","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":1249.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC TOTAL BODY SYSTEMIC HYPOTHERMIA PER DAY, 1:1 NURSING RATIO","code_information":[{"code":"3610900","type":"CDM"},{"code":"0361","type":"RC"},{"code":"3610900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1911.0,"discounted_cash":1146.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36510 UVC (UMBILICAL VEIN CATH) FOR NEWBORN","code_information":[{"code":"3610901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":220.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJECTION INTO BRAIN CANAL","code_information":[{"code":"3610905","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61026","type":"HCPCS"}],"standard_charges":[{"gross_charge":3716.0,"discounted_cash":2229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33221 INSERT PACEMAKER PULS GEN ONLY EXIST MLT LEADS","code_information":[{"code":"3610906","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33221","type":"HCPCS"}],"standard_charges":[{"gross_charge":32627.0,"discounted_cash":19576.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33227 REMOVE/REPLACE PACEMAKER PULS GEN SNG LEAD","code_information":[{"code":"3610907","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":29746.0,"discounted_cash":17847.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33228 REMOVE/REPLACE PACEMAKER PULS GEN DUAL LEAD","code_information":[{"code":"3610908","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":28615.0,"discounted_cash":17169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33229 REMOVE/REPLACE PACKEMAKER PULS GEN MULT LEAD","code_information":[{"code":"3610909","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33229","type":"HCPCS"}],"standard_charges":[{"gross_charge":30983.0,"discounted_cash":18589.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33230 INSERT ICD PULSE GEN ONLY EXIST DUAL LEAD","code_information":[{"code":"3610910","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33230","type":"HCPCS"}],"standard_charges":[{"gross_charge":43419.0,"discounted_cash":26051.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33231 INSERT ICD PULSE GEN ONLY EXIST MULT LEAD","code_information":[{"code":"3610911","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33231","type":"HCPCS"}],"standard_charges":[{"gross_charge":39769.0,"discounted_cash":23861.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33263 REMOVE/REPLACE ICD PULS GEN DUAL LEAD","code_information":[{"code":"3610913","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":45842.0,"discounted_cash":27505.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33264 REMOVE/REPLACE ICD PULS GEN MULT LEAD","code_information":[{"code":"3610914","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":51828.0,"discounted_cash":31096.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36251 SEL CATH PLACE MAIN RENAL ART W RAD S&I UNILAT","code_information":[{"code":"3610915","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":7158.0,"discounted_cash":4294.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36252 SEL CATH PLACE MAIN RENAL ART W RAD S&I  BILAT","code_information":[{"code":"3610916","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":10738.0,"discounted_cash":6442.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36253 SPRSEL CATH PLACE RENAL ART SEC ORDER UNIL","code_information":[{"code":"3610917","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36253","type":"HCPCS"}],"standard_charges":[{"gross_charge":7566.0,"discounted_cash":4539.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36254 SPRSEL CATH PLACE RENAL ART SEC ORDER BILAT","code_information":[{"code":"3610918","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36254","type":"HCPCS"}],"standard_charges":[{"gross_charge":11348.0,"discounted_cash":6808.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37191 INSERT INTRAVASC VENA CAVA FILT W IMAG GUID","code_information":[{"code":"3610919","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":13596.0,"discounted_cash":8157.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37192 REPOSITION INTRAVASC VENA CAVA FILT W IMAG GUID","code_information":[{"code":"3610920","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37192","type":"HCPCS"}],"standard_charges":[{"gross_charge":9584.0,"discounted_cash":5750.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37193 REMOVAL INTRAVASC VENA CAVA FILT  W IMAG GUID","code_information":[{"code":"3610921","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":9584.0,"discounted_cash":5750.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49082 ABD PARACENTESIS W/O IMAG GUID","code_information":[{"code":"3610922","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":1021.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49083 ABD PARACENTESIS WITH IMAG GUID","code_information":[{"code":"3610923","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2187.0,"discounted_cash":1312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33262 REMOVE/REPLACE ICD PULS GEN SNGL LEAD","code_information":[{"code":"3610940","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":40337.0,"discounted_cash":24202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BX SOFT TISSUE PELVIS/HIP; SUPERFICIAL","code_information":[{"code":"3610945","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27040","type":"HCPCS"}],"standard_charges":[{"gross_charge":4777.0,"discounted_cash":2866.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 57156 INSERT VAG RADIAT AFTERLOAD APPARATUS","code_information":[{"code":"3610951","type":"CDM"},{"code":"0333","type":"RC"},{"code":"57156","type":"HCPCS"}],"standard_charges":[{"gross_charge":1837.0,"discounted_cash":1102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIOPSY SOFT TISS SHOULDER AREA SUPERFICIAL","code_information":[{"code":"3610955","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23065","type":"HCPCS"}],"standard_charges":[{"gross_charge":4896.0,"discounted_cash":2937.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIOPSY SOF TISS SHOULDER AREA DEEP","code_information":[{"code":"3610956","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23066","type":"HCPCS"}],"standard_charges":[{"gross_charge":13752.0,"discounted_cash":8251.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, PERC FEM ART APPR","code_information":[{"code":"3610969","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33361","type":"HCPCS"}],"standard_charges":[{"gross_charge":63979.0,"discounted_cash":38387.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, OPEN FEM ART APPR","code_information":[{"code":"3610970","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33362","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, OPEN AXIL ART APPR","code_information":[{"code":"3610971","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33363","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, OPEN ILIAC ART APPR","code_information":[{"code":"3610972","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33364","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, TRANSAORTIC APPR","code_information":[{"code":"3610973","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33365","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, W/BYPASS W/PERC PER ART & VEN CANN","code_information":[{"code":"3610974","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33367","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, W/BYPASS W/OPEN PER ART & VEN CANN","code_information":[{"code":"3610975","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33368","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE, W/BYPASS W/CENT ART & VEN CANN","code_information":[{"code":"3610976","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33369","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32554 THORACENTESIS NDL/CATH ASP PLEURL SPC W/O IMG GD - RT","code_information":[{"code":"3610977","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.0,"discounted_cash":971.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32554 THORACENTESIS NDL/CATH ASP PLEURL SPC W/O IMG GD - LT","code_information":[{"code":"3610978","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1619.0,"discounted_cash":971.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD RT","code_information":[{"code":"3610979","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6281.0,"discounted_cash":3768.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD LT","code_information":[{"code":"3610980","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6281.0,"discounted_cash":3768.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD BLT","code_information":[{"code":"3610981","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":9421.0,"discounted_cash":5652.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37212 TRANSCATH VENOUS INFUS THROMBOLYSIS NON-CORON INIT DAY","code_information":[{"code":"3610983","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37212","type":"HCPCS"}],"standard_charges":[{"gross_charge":3381.0,"discounted_cash":2028.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37213 TRANSCATH ART/VENOUS THROMBOLYSIS SUBSEQ DAY","code_information":[{"code":"3610984","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37213","type":"HCPCS"}],"standard_charges":[{"gross_charge":3343.0,"discounted_cash":2005.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37214 TRANSCATH ART/VENOUS THROMBOLYSIS CESSATION","code_information":[{"code":"3610986","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":3343.0,"discounted_cash":2005.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37197 TRANSCATH RETRIEVAL PERC OF INTRAVASC FB INC IMAG GUID","code_information":[{"code":"3610988","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":10450.0,"discounted_cash":6270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32556 PLEURAL DRAIN PERC W/CATH INSERT W/O IMAG GUID-RT","code_information":[{"code":"3610989","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32556 PLEURAL DRAIN PERC W/CATH INSERT W/O IMAG GUID-LT","code_information":[{"code":"3610990","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32557 PLEURAL DRAIN PERC W/CATH INSERT W/IMAG GUID-RT","code_information":[{"code":"3610992","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3282.0,"discounted_cash":1969.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32557 PLEURAL DRAIN PERC W/CATH INSERT W/IMAG GUID-LT","code_information":[{"code":"3610993","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3282.0,"discounted_cash":1969.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32557 PLEURAL DRAIN PERC W/CATH INSERT W/IMAG GUID-BLT","code_information":[{"code":"3610994","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":4920.0,"discounted_cash":2952.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 33990 INSERT VAD  PERC INC RAD SUP & INTERP LEFT HEART ART ACCESS ONLY","code_information":[{"code":"3610995","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33990","type":"HCPCS"}],"standard_charges":[{"gross_charge":6439.0,"discounted_cash":3863.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33991 INSERT VAD  PERC INC RAD SUP & INTERP LEFT HEART W/TRANSSEPT PUNCT","code_information":[{"code":"3610996","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33991","type":"HCPCS"}],"standard_charges":[{"gross_charge":8042.0,"discounted_cash":4825.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33992 REMOVE PERC VAD LEFT HEART SEPARATE SESSION FROM INSERT","code_information":[{"code":"3610997","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33992","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33993 REPOSITION PERC VAD RIGHT OR LEFT W/ IMAG GUID AT SEP SESSION FROM INSERT","code_information":[{"code":"3610998","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33993","type":"HCPCS"}],"standard_charges":[{"gross_charge":4831.0,"discounted_cash":2898.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHEMODENERV MUSCLE(S)-FACIAL NERVE-LT","code_information":[{"code":"3611001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":930.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CHEMODENERV MUSCLE(S)-FACIAL NERVE-RT","code_information":[{"code":"3611002","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":1551.0,"discounted_cash":930.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CHEMODENERV MUSCLE(S)-FACIAL NERVE-BLT","code_information":[{"code":"3611003","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64612","type":"HCPCS"}],"standard_charges":[{"gross_charge":2320.0,"discounted_cash":1392.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC TENOTOMY PERCUTANEOUS TOE; SINGLE TENDON","code_information":[{"code":"3611012","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":6600.0,"discounted_cash":3960.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT EPICARDIAL ELECTRODE ENDOSC APPR","code_information":[{"code":"3611013","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33203","type":"HCPCS"}],"standard_charges":[{"gross_charge":3877.0,"discounted_cash":2326.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC APPL SHORT ARM SPLINT, DYNAMIC, RT","code_information":[{"code":"3611014","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":397.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC  APPL SHORT ARM SPLINT, DYNAMIC, LT","code_information":[{"code":"3611015","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":397.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH-LT","code_information":[{"code":"3611017","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28272","type":"HCPCS"}],"standard_charges":[{"gross_charge":9875.0,"discounted_cash":5925.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH-RT","code_information":[{"code":"3611018","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28272","type":"HCPCS"}],"standard_charges":[{"gross_charge":9875.0,"discounted_cash":5925.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69210 REMOVE IMPACT CERUMEN W/INSTRUMENTS-RT","code_information":[{"code":"3611020","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69210 REMOVE IMPACT CERUMEN W/INSTRUMENTS-LT","code_information":[{"code":"3611021","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69210 REMOVE IMPACT CERUMEN W/INSTRUMENTS-BLT","code_information":[{"code":"3611022","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":397.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 10030 IMAGE-GUIDED FLUID DRAINAGE BY CATH SOFT TISSUE PERC","code_information":[{"code":"3611023","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2729.0,"discounted_cash":1637.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION STEREOTACTIC-RT","code_information":[{"code":"3611024","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":8355.0,"discounted_cash":5013.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION STEREOTACTIC-LT","code_information":[{"code":"3611025","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":8355.0,"discounted_cash":5013.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION STEREOTACTIC-BLT","code_information":[{"code":"3611026","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":12530.0,"discounted_cash":7518.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION STEREOTACTIC-RT","code_information":[{"code":"3611027","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":6439.0,"discounted_cash":3863.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION STEREOTACTIC-LT","code_information":[{"code":"3611028","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":6439.0,"discounted_cash":3863.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION STEREOTACTIC-BLT","code_information":[{"code":"3611029","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":9657.0,"discounted_cash":5794.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION US IMAG-RT","code_information":[{"code":"3611030","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":6722.0,"discounted_cash":4033.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION US IMAG-LT","code_information":[{"code":"3611031","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":6722.0,"discounted_cash":4033.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION US IMAG-BLT","code_information":[{"code":"3611032","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":10080.0,"discounted_cash":6048.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION US IMAG-RT","code_information":[{"code":"3611033","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":5302.0,"discounted_cash":3181.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION US IMAG-LT","code_information":[{"code":"3611034","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":5302.0,"discounted_cash":3181.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION US IMAG-BLT","code_information":[{"code":"3611035","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":7950.0,"discounted_cash":4770.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION - MRI-RT","code_information":[{"code":"3611036","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":8026.0,"discounted_cash":4815.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION - MRI-LT","code_information":[{"code":"3611037","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":8026.0,"discounted_cash":4815.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT 1ST LESION - MRI-BLT","code_information":[{"code":"3611038","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":12040.0,"discounted_cash":7224.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION - MRI -RT","code_information":[{"code":"3611039","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":5302.0,"discounted_cash":3181.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION - MRI -LT","code_information":[{"code":"3611040","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":5302.0,"discounted_cash":3181.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BREAST BX W DEVICE PLACEMENT EA ADD'L LESION - MRI -BLT","code_information":[{"code":"3611041","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":7950.0,"discounted_cash":4770.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37241 VASCULAR EMBOLIZATION/OCCLUSION VENOUS","code_information":[{"code":"3611043","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37241","type":"HCPCS"}],"standard_charges":[{"gross_charge":34546.0,"discounted_cash":20727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37242 VASCULAR EMBOLIZATION/OCCLUSION ARTERIAL","code_information":[{"code":"3611044","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":34546.0,"discounted_cash":20727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37243 VASCULAR EMBOLIZATION/OCCLUSION TUMOR/ORGAN","code_information":[{"code":"3611045","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":34546.0,"discounted_cash":20727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37244 VASCULAR EMBOLIZATION/OCCLUSION BLEED","code_information":[{"code":"3611046","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":34546.0,"discounted_cash":20727.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37236 TRANSCATH PLACE STENT OPEN/PERQ INITIAL ARTERY","code_information":[{"code":"3611047","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37236","type":"HCPCS"}],"standard_charges":[{"gross_charge":34000.0,"discounted_cash":20400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37237 TRANSCATH PLACE STENT OPEN/PERQ EA ADD'L ARTERY","code_information":[{"code":"3611048","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37237","type":"HCPCS"}],"standard_charges":[{"gross_charge":36596.0,"discounted_cash":21957.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37238 TRANSCATH PLACE STENT OPEN/PERQ INITIAL VEIN","code_information":[{"code":"3611049","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":38334.0,"discounted_cash":23000.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37239 TRANSCATH PLACE STENT OPEN/PERQ EA ADD'L VEIN","code_information":[{"code":"3611050","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37239","type":"HCPCS"}],"standard_charges":[{"gross_charge":38334.0,"discounted_cash":23000.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49405 IMAGE-GUIDED FLUID DRAINAGE BY CATH; VISCERAL PERC","code_information":[{"code":"3611051","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3971.0,"discounted_cash":2382.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49406 IMAGE-GUIDED FLUID DRAINAGE BY CATH; PERITONEAL/RETRO PERC","code_information":[{"code":"3611052","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4448.0,"discounted_cash":2668.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHEMODENERVATION NECK MUSCLES - EXCL LARYRNX-RT","code_information":[{"code":"3611054","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1387.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CHEMODENERVATION NECK MUSCLES - EXCL LARYRNX-LT","code_information":[{"code":"3611055","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1387.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CHEMODENERVATION NECK MUSCLES - EXCL LARYRNX-BLT","code_information":[{"code":"3611056","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64616","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.0,"discounted_cash":2080.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC CHEMODENERVATION-1 EXTREMITY 1-4 MUSCLES","code_information":[{"code":"3611057","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64642","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHEMODENERV-1 EXTREM EA ADD'L EXT 1-4 MUSCLES","code_information":[{"code":"3611058","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64643","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHEMODENERVATION-1 EXTREMITY >= 5 MUSCLES","code_information":[{"code":"3611059","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64644","type":"HCPCS"}],"standard_charges":[{"gross_charge":2911.0,"discounted_cash":1746.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHEMODENERV-1 EXTREM; EA ADD'L EX >= 5 MUSCLES","code_information":[{"code":"3611060","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2911.0,"discounted_cash":1746.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHEMODENERVATION TRUNK MUSCLES 1-5 MUSCLES","code_information":[{"code":"3611061","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64646","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CHEMODENERVATION TRUNK MUSCLES >= 6 MUSCLES","code_information":[{"code":"3611062","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64647","type":"HCPCS"}],"standard_charges":[{"gross_charge":2911.0,"discounted_cash":1746.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TAVR/TAVI W/PROS VALVE,TRANSAPICAL EXPOSURE","code_information":[{"code":"3611071","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33366","type":"HCPCS"}],"standard_charges":[{"gross_charge":63222.0,"discounted_cash":37933.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION W/IMAG-RT","code_information":[{"code":"3611073","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":2628.0,"discounted_cash":1576.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION W/IMAG-LT","code_information":[{"code":"3611074","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":2628.0,"discounted_cash":1576.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION W/IMAG-BLT","code_information":[{"code":"3611075","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":4244.0,"discounted_cash":2546.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION W/IMAG-RT","code_information":[{"code":"3611076","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":932.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION W/IMAG-LT","code_information":[{"code":"3611077","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":932.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION W/IMAG-BLT","code_information":[{"code":"3611078","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19282","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.0,"discounted_cash":1397.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION STEREOTACTIC-RT","code_information":[{"code":"3611079","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":1606.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION STEREOTACTIC-LT","code_information":[{"code":"3611080","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":2678.0,"discounted_cash":1606.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION STEREOTACTIC-BLT","code_information":[{"code":"3611081","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19283","type":"HCPCS"}],"standard_charges":[{"gross_charge":4019.0,"discounted_cash":2411.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION STEREOTACTIC-RT","code_information":[{"code":"3611082","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":932.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION STEREOTACTIC-LT","code_information":[{"code":"3611083","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":932.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION STEREOTACTIC-BLT","code_information":[{"code":"3611084","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19284","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.0,"discounted_cash":1397.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION ULTRASOUND-RT","code_information":[{"code":"3611085","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2973.0,"discounted_cash":1783.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION ULTRASOUND-LT","code_information":[{"code":"3611086","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2973.0,"discounted_cash":1783.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION ULTRASOUND-BLT","code_information":[{"code":"3611087","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":4459.0,"discounted_cash":2675.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION ULTRASOUND-RT","code_information":[{"code":"3611088","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":932.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION ULTRASOUND-LT","code_information":[{"code":"3611089","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":932.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION ULTRASOUND-BLT","code_information":[{"code":"3611090","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.0,"discounted_cash":1397.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION MRI - RT","code_information":[{"code":"3611091","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":8026.0,"discounted_cash":4815.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION MRI - LT","code_information":[{"code":"3611092","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":8026.0,"discounted_cash":4815.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC 1ST LESION MRI - BLT","code_information":[{"code":"3611093","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19287","type":"HCPCS"}],"standard_charges":[{"gross_charge":12040.0,"discounted_cash":7224.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION MRI - RT","code_information":[{"code":"3611094","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19288","type":"HCPCS"}],"standard_charges":[{"gross_charge":8026.0,"discounted_cash":4815.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION MRI - LT","code_information":[{"code":"3611095","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19288","type":"HCPCS"}],"standard_charges":[{"gross_charge":8026.0,"discounted_cash":4815.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PLCMT BRST LOC DEVICE PERC EA ADD'L LESION MRI - BLT","code_information":[{"code":"3611096","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19288","type":"HCPCS"}],"standard_charges":[{"gross_charge":12040.0,"discounted_cash":7224.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC LAP BAND ADJUSTMENT","code_information":[{"code":"3611102","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43999","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"discounted_cash":598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PUNCTURE ASPIRATION OF HYDROCELE RT","code_information":[{"code":"3611136","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.0,"discounted_cash":1182.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PUNCTURE ASPIRATION OF HYDROCELE LT","code_information":[{"code":"3611137","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.0,"discounted_cash":1182.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 22510 PERQ VERTEBROPLASTY, 1 VERT BODY, UNI/BIL INJ, INJECT; CERVICOTHORACIC","code_information":[{"code":"3611139","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22510","type":"HCPCS"}],"standard_charges":[{"gross_charge":7930.0,"discounted_cash":4758.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22511 PERQ VERTEBROPLASTY, 1 VERT BODY, UNI/BIL INJ, INJECT; LUMBOSACRAL","code_information":[{"code":"3611140","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22511","type":"HCPCS"}],"standard_charges":[{"gross_charge":10496.0,"discounted_cash":6297.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22512 PERQ VERTEBROPLASTY EA ADDL INJECT; CERVICOTHOR/LUMBOSACRAL","code_information":[{"code":"3611141","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":7938.0,"discounted_cash":4762.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22513 PERQ VERTEBRAL AUGMENTATION, 1 VERT BODY, UNI/BIL; THORACIC","code_information":[{"code":"3611142","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":16088.0,"discounted_cash":9652.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22514 PERQ VERTEBRAL AUGMENTATION, 1 VERT BODY, UNI/BIL; LUMBAR","code_information":[{"code":"3611143","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22514","type":"HCPCS"}],"standard_charges":[{"gross_charge":16088.0,"discounted_cash":9652.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22515 PERQ VERTEBRAL AUGMENTATION, 1 VERT BODY, EA ADDTL; THORACIC OR LUMBAR","code_information":[{"code":"3611144","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22515","type":"HCPCS"}],"standard_charges":[{"gross_charge":15677.0,"discounted_cash":9406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62302 MYELOGRAPHY VIA LUMBAR INJECTION, INC RS&I; CERVICAL","code_information":[{"code":"3611145","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":4754.0,"discounted_cash":2852.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62303 MYELOGRAPHY VIA LUMBAR INJECTION, INC RS&I; THORACIC","code_information":[{"code":"3611146","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":4754.0,"discounted_cash":2852.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62304 MYELOGRAPHY VIA LUMBAR INJECTION, INC RS&I; LUMBOSACRAL","code_information":[{"code":"3611147","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":4754.0,"discounted_cash":2852.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62305 MYELOGRAPHY VIA LUMBAR INJECTION, INC RS&I; 2 OR MORE REGIONS","code_information":[{"code":"3611148","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":5588.0,"discounted_cash":3352.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33272 REMOVAL OF SUBQ IMPLANTABLE DEFIBILLATOR ELECTRODE","code_information":[{"code":"3611149","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33272","type":"HCPCS"}],"standard_charges":[{"gross_charge":5701.0,"discounted_cash":3420.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPOSITION OF PREVIOUS IMPLANTED SUBQ IMPLT DEFIB ELECTRODE","code_information":[{"code":"3611150","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33273","type":"HCPCS"}],"standard_charges":[{"gross_charge":4885.0,"discounted_cash":2931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCATH STENT PLACEMENT, ANTEGRADE APPROACH, CAROTID/INNOMINATE","code_information":[{"code":"3611151","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37218","type":"HCPCS"}],"standard_charges":[{"gross_charge":5701.0,"discounted_cash":3420.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33270 INSERT OR REPLACE PERM SUBQ IMPLANTABLE DEFIB SYSTEM W SUBQ ELECTRODE","code_information":[{"code":"3611152","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33270","type":"HCPCS"}],"standard_charges":[{"gross_charge":51544.0,"discounted_cash":30926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33271 INSERTION OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE","code_information":[{"code":"3611155","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33271","type":"HCPCS"}],"standard_charges":[{"gross_charge":51544.0,"discounted_cash":30926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHOCENTESIS, ASPIRATION/INJECT, MAJOR JOINT/BURSA; W US, REC/REPORT -RT","code_information":[{"code":"3611162","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2941.0,"discounted_cash":1764.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHOCENTESIS, ASPIRATION/INJECT, MAJOR JOINT/BURSA; W US, REC/REPORT -LT","code_information":[{"code":"3611163","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":2941.0,"discounted_cash":1764.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHOCENTESIS, ASPIRATION/INJECT, MAJOR JOINT/BURSA; W US, REC/REPORT -BLT","code_information":[{"code":"3611164","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":4411.0,"discounted_cash":2646.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20600 INJ ARTHRO,SM JT/BURSA/GANG-W/O US GUIDE - RT","code_information":[{"code":"3611167","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.0,"discounted_cash":755.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20600 INJ ARTHRO,SM JT/BURSA/GANG-W/O US GUIDE - LT","code_information":[{"code":"3611168","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1259.0,"discounted_cash":755.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 INJ ARTHRO, INTRM JT/BURSA/GAN W/O US GUIDE-RT","code_information":[{"code":"3611169","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1329.0,"discounted_cash":797.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 INJ ARTHRO, INTRM JT/BURSA/GAN W/O US GUIDE-LT","code_information":[{"code":"3611170","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1329.0,"discounted_cash":797.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 INJ ARTHRO MAJOR JT/BURSA/GAN W/O US GUIDE-LT","code_information":[{"code":"3611171","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.0,"discounted_cash":738.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TRNSCATH STENT,CERV/CAROTID-OPEN OR PERC- AND PTA & R&I WO/EMB PROTECT","code_information":[{"code":"3611172","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37216","type":"HCPCS"}],"standard_charges":[{"gross_charge":9535.0,"discounted_cash":5721.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20610 INJ ARTHRO, MAJOR JT/BURSA/GAN; WO US GUIDE-RT","code_information":[{"code":"3611176","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1230.0,"discounted_cash":738.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 INJ ARTHRO,MAJOR JOINT/BURSA/GAN; WO GUIDE-BLT","code_information":[{"code":"3611177","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.0,"discounted_cash":1210.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC SURG PREP FOR GRAFT 1ST 100 SQ CM","code_information":[{"code":"3611179","type":"CDM"},{"code":"0361","type":"RC"},{"code":"15004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1861.0,"discounted_cash":1116.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRNSCATH STENT,CERV/CAROTID-OPEN OR PERC- AND PTA & R&I W EMB PROTECT","code_information":[{"code":"3611180","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37215","type":"HCPCS"}],"standard_charges":[{"gross_charge":19030.0,"discounted_cash":11418.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33999 UNLISTED PROCEDURE, CARDIAC SURGERY","code_information":[{"code":"3611186","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1952.0,"discounted_cash":1171.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERQ DEVCE SOFT TISS 1ST IMAG","code_information":[{"code":"3611197","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10035","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"discounted_cash":598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERQ DEVCE SOFT TISS ADDL IMAG","code_information":[{"code":"3611198","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10036","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCH EBUS SAMPLG 1-2 NODE","code_information":[{"code":"3611199","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31652","type":"HCPCS"}],"standard_charges":[{"gross_charge":7431.0,"discounted_cash":4458.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCH EBUS SAMPLG 3/> NODE","code_information":[{"code":"3611200","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31653","type":"HCPCS"}],"standard_charges":[{"gross_charge":11329.0,"discounted_cash":6797.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCH EBUS IVTNJ PERPH L","code_information":[{"code":"3611201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31654","type":"HCPCS"}],"standard_charges":[{"gross_charge":2630.0,"discounted_cash":1578.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37184 PRIM ART M-THROMBC 1ST VSL","code_information":[{"code":"3611202","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":19790.0,"discounted_cash":11874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37185 PRIM ART M-THROMBC SBSQ VSL","code_information":[{"code":"3611203","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":7316.0,"discounted_cash":4389.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37186 SEC ART THROMBC ADD ON","code_information":[{"code":"3611204","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37186","type":"HCPCS"}],"standard_charges":[{"gross_charge":7316.0,"discounted_cash":4389.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37211 TRNSCTH ART INFUS LYSIS NO-HEART/BRAIN 1ST  DAY","code_information":[{"code":"3611205","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37211","type":"HCPCS"}],"standard_charges":[{"gross_charge":5767.0,"discounted_cash":3460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37252 IVUS (NON-CORONARY) RS&I, INITIAL VESS","code_information":[{"code":"3611206","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3410.0,"discounted_cash":2046.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37253 IVUS (NON-CORONARY) RS&I, EA ADDL VESS","code_information":[{"code":"3611207","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":3410.0,"discounted_cash":2046.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47531 INJ FOR CHOLANGIO VIA EXISTING ACCESS","code_information":[{"code":"3611208","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":3456.0,"discounted_cash":2073.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47532 INJ FOR CHOLANGIO VIA NEW ACCESS","code_information":[{"code":"3611209","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47532","type":"HCPCS"}],"standard_charges":[{"gross_charge":3456.0,"discounted_cash":2073.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47533 PLACE BILIARY DRAIN CATH EXTERNAL","code_information":[{"code":"3611210","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":10933.0,"discounted_cash":6559.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47534 PLACE BILIARY DRAIN CATH INTRNL-EXTRNL","code_information":[{"code":"3611211","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47534","type":"HCPCS"}],"standard_charges":[{"gross_charge":12360.0,"discounted_cash":7416.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47535 CONVERSION EXT BILI DRAIN CATH TO INT-EXT","code_information":[{"code":"3611212","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47535","type":"HCPCS"}],"standard_charges":[{"gross_charge":7648.0,"discounted_cash":4588.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47536 EXCHANGE BILIARY DRAIN CATH","code_information":[{"code":"3611213","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":6715.0,"discounted_cash":4029.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47537 REMOVAL BILIARY DRAIN CATH","code_information":[{"code":"3611214","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47537","type":"HCPCS"}],"standard_charges":[{"gross_charge":1656.0,"discounted_cash":993.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47538 PERC PLACE BILI STENT VIA EXISTING ACCESS","code_information":[{"code":"3611215","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47538","type":"HCPCS"}],"standard_charges":[{"gross_charge":14774.0,"discounted_cash":8864.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47541 PERC PLACE NEW ACCESS BILI TREE TO SM BOWEL","code_information":[{"code":"3611218","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47541","type":"HCPCS"}],"standard_charges":[{"gross_charge":7799.0,"discounted_cash":4679.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47542 DILATE BILI DUCT/AMPULLA + IMG, PERQ","code_information":[{"code":"3611219","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47542","type":"HCPCS"}],"standard_charges":[{"gross_charge":8057.0,"discounted_cash":4834.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 47544 PERC REMOVAL BILI DUCT/GALLBLADDER CALCULI","code_information":[{"code":"3611221","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47544","type":"HCPCS"}],"standard_charges":[{"gross_charge":3134.0,"discounted_cash":1880.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 50430 INJ PRO PYELO/URETEROGRAM VIA NEW CATH LT","code_information":[{"code":"3611222","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":974.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50430 INJ PRO PYELO/URETEROGRAM VIA NEW CATH RT","code_information":[{"code":"3611223","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":974.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50430 INJ PRO PYELO/URETEROGRAM VIA NEW CATH BLT","code_information":[{"code":"3611224","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2436.0,"discounted_cash":1461.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50431 INJ PRO PYELO/URETEROGRAM VIA EXIST CATH LT","code_information":[{"code":"3611225","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":974.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50431 INJ PRO PYELO/URETEROGRAM VIA EXIST CATH RT","code_information":[{"code":"3611226","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":974.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50431 INJ PRO PYELO/URETEROGRM VIA EXIST CATH BLT","code_information":[{"code":"3611227","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":2436.0,"discounted_cash":1461.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50432 PERC PLACE NEPHROSTOMY CATHETER LT","code_information":[{"code":"3611228","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":6471.0,"discounted_cash":3882.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50432 PERC PLACE NEPHROSTOMY CATHETER RT","code_information":[{"code":"3611229","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":6471.0,"discounted_cash":3882.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50432 PERC PLACE NEPHROSTOMY CATHETER BLT","code_information":[{"code":"3611230","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":8249.0,"discounted_cash":4949.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50433 PERC PLACE NEPHROURETER CATH VIA NEW ACC LT","code_information":[{"code":"3611231","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":4211.0,"discounted_cash":2526.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50433 PERC PLACE NEPHROURETER CATH VIA NEW ACC RT","code_information":[{"code":"3611232","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":4533.0,"discounted_cash":2719.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50433 PERC PLACE NEPHROURETR CATH VIA NEW ACC BLT","code_information":[{"code":"3611233","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":4080.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50434 CONVERT NEPHROSTOMY TO NEPHROURETER CATH LT","code_information":[{"code":"3611234","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":6959.0,"discounted_cash":4175.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50434 CONVERT NEPHROSTOMY TO NEPHROURETER CATH RT","code_information":[{"code":"3611235","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":6959.0,"discounted_cash":4175.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50434 CONVERT NEPHROSTOMY TO NEPHROURETR CATH BLT","code_information":[{"code":"3611236","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":9943.0,"discounted_cash":5965.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50435 EXCHANGE NEPHROSTOMY CATH LT","code_information":[{"code":"3611237","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":5579.0,"discounted_cash":3347.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50435 EXCHANGE NEPHROSTOMY CATH RT","code_information":[{"code":"3611238","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":5579.0,"discounted_cash":3347.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50435 EXCHANGE NEPHROSTOMY CATH BLT","code_information":[{"code":"3611239","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":8459.0,"discounted_cash":5075.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50693 PERC PLACE URETERAL STENT VIA NEPHRSTMY LT","code_information":[{"code":"3611240","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":7491.0,"discounted_cash":4494.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50693 PERC PLACE URETERAL STENT VIA NEPHRSTMY RT","code_information":[{"code":"3611241","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":7491.0,"discounted_cash":4494.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50693 PERC PLACE URETERAL STENT VIA NEPHRSTMY BLT","code_information":[{"code":"3611242","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":9943.0,"discounted_cash":5965.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50694 PERC URETERAL STENT NEW ACC WO SEP CATH  LT","code_information":[{"code":"3611243","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":7491.0,"discounted_cash":4494.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50694 PERC URETERAL STENT NEW ACC WO SEP CATH  RT","code_information":[{"code":"3611244","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":7491.0,"discounted_cash":4494.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50694 PERC URETERL STENT NEW ACC WO SEP CATH  BLT","code_information":[{"code":"3611245","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":9943.0,"discounted_cash":5965.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 50695 PERC URETERAL STENT NEW ACC W/SEP CATH  LT","code_information":[{"code":"3611246","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50695","type":"HCPCS"}],"standard_charges":[{"gross_charge":13961.0,"discounted_cash":8376.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50695 PERC URETERAL STENT NEW ACC W/SEP CATH  RT","code_information":[{"code":"3611247","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50695","type":"HCPCS"}],"standard_charges":[{"gross_charge":13961.0,"discounted_cash":8376.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 50695 PERC URETERAL STENT NEW ACC W/SEP CATH  BLT","code_information":[{"code":"3611248","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50695","type":"HCPCS"}],"standard_charges":[{"gross_charge":18192.0,"discounted_cash":10915.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC ENDOLUMINAL BIOPSY RENAL PELVIS/URETER LT","code_information":[{"code":"3611249","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50606","type":"HCPCS"}],"standard_charges":[{"gross_charge":6236.0,"discounted_cash":3741.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ENDOLUMINAL BIOPSY RENAL PELVIS/URETER RT","code_information":[{"code":"3611250","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50606","type":"HCPCS"}],"standard_charges":[{"gross_charge":6236.0,"discounted_cash":3741.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ENDOLUMINAL BIOPSY RENAL PELVIS/URETER BLT","code_information":[{"code":"3611251","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50606","type":"HCPCS"}],"standard_charges":[{"gross_charge":9355.0,"discounted_cash":5613.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC PERQ ART M-THROMBECTOMY & INFUSION","code_information":[{"code":"3611252","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61645","type":"HCPCS"}],"standard_charges":[{"gross_charge":19172.0,"discounted_cash":11503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EVASC PROLONG ADMIN RX AGENT, INITIAL","code_information":[{"code":"3611253","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61650","type":"HCPCS"}],"standard_charges":[{"gross_charge":20755.0,"discounted_cash":12453.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EVASC PROLONG ADMIN RX AGENT, EA ADDL","code_information":[{"code":"3611254","type":"CDM"},{"code":"0361","type":"RC"},{"code":"61651","type":"HCPCS"}],"standard_charges":[{"gross_charge":20755.0,"discounted_cash":12453.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49185 SCLERO TX FLUID COLLECTION","code_information":[{"code":"3611255","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49185","type":"HCPCS"}],"standard_charges":[{"gross_charge":3711.0,"discounted_cash":2226.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 50706 BALLOON DILATE URETERAL STRICTURE + RS&I","code_information":[{"code":"3611257","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50706","type":"HCPCS"}],"standard_charges":[{"gross_charge":8846.0,"discounted_cash":5307.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL OF IMPLANT, DEEP","code_information":[{"code":"3611259","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":8482.0,"discounted_cash":5089.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX PROX HUMERAL FX W/O MANIP-RT","code_information":[{"code":"3611265","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":711.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36473 ENDOVEN ABLATION MECHCHEM 1ST VEIN - RT","code_information":[{"code":"3611289","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36473","type":"HCPCS"}],"standard_charges":[{"gross_charge":8174.0,"discounted_cash":4904.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36473 ENDOVEN ABLATION MECHCHEM 1ST VEIN - LT","code_information":[{"code":"3611290","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36473","type":"HCPCS"}],"standard_charges":[{"gross_charge":8174.0,"discounted_cash":4904.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36474 ENDOVEN ABLATION MECHCHEM ADDL VEINS SEPARATE SITES - RT","code_information":[{"code":"3611291","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36474","type":"HCPCS"}],"standard_charges":[{"gross_charge":8105.0,"discounted_cash":4863.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36474 ENDOVEN ABLATION MECHCHEM ADDL VEINS SEPARATE SITES - LT","code_information":[{"code":"3611292","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36474","type":"HCPCS"}],"standard_charges":[{"gross_charge":8105.0,"discounted_cash":4863.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36901 DIALYSIS CIRCUIT IMAGING - RT","code_information":[{"code":"3611293","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":2735.0,"discounted_cash":1641.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36901 DIALYSIS CIRCUIT IMAGING - LT","code_information":[{"code":"3611294","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":2735.0,"discounted_cash":1641.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36902 DIALYSIS CIRCUIT IMAGING W/BALLOON INFLATION - RT","code_information":[{"code":"3611295","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":19272.0,"discounted_cash":11563.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36902 DIALYSIS CIRCUIT IMAGING W/BALLOON INFLATION - LT","code_information":[{"code":"3611296","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":19272.0,"discounted_cash":11563.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36903 DIALYSIS CIRCUIT IMAGING, STENTING AND BALLOON INFLATION - RT","code_information":[{"code":"3611297","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36903","type":"HCPCS"}],"standard_charges":[{"gross_charge":38955.0,"discounted_cash":23373.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36903 DIALYSIS CIRCUIT IMAGING, STENTING AND BALLOON INFLATION - LT","code_information":[{"code":"3611298","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36903","type":"HCPCS"}],"standard_charges":[{"gross_charge":38955.0,"discounted_cash":23373.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36904 DIALYSIS CIRCUIT IMAGING AND CLOT CLEARING - RT","code_information":[{"code":"3611299","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":19428.0,"discounted_cash":11656.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36904 DIALYSIS CIRCUIT IMAGING AND CLOT CLEARING - LT","code_information":[{"code":"3611300","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":19428.0,"discounted_cash":11656.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36905 DIALYSIS CIRCUIT IMAGING & CLOT CLEARING &/OR BALLOON - RT","code_information":[{"code":"3611301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":39115.0,"discounted_cash":23469.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36905 DIALYSIS CIRCUIT IMAGING & CLOT CLEARING &/OR BALLOON - LT","code_information":[{"code":"3611302","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":39115.0,"discounted_cash":23469.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36906 DIALYSIS CIRCUIT IMAGING & CLOT CLEARING, BALLOON  & STENT- RT","code_information":[{"code":"3611303","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36906","type":"HCPCS"}],"standard_charges":[{"gross_charge":59097.0,"discounted_cash":35458.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36906 DIALYSIS CIRCUIT IMAGING & CLOT CLEARING, BALLOON  & STENT- LT","code_information":[{"code":"3611304","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36906","type":"HCPCS"}],"standard_charges":[{"gross_charge":59097.0,"discounted_cash":35458.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36907 DIALYSIS CENTRAL SEGMENT IMAGING AND BALLOON - RT","code_information":[{"code":"3611305","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":19272.0,"discounted_cash":11563.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36907 DIALYSIS CENTRAL SEGMENT IMAGING AND BALLOON - LT","code_information":[{"code":"3611306","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36907","type":"HCPCS"}],"standard_charges":[{"gross_charge":19272.0,"discounted_cash":11563.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36908 DIALYSIS CENTRAL SEGMENT STENT AND BALLOON - RT","code_information":[{"code":"3611307","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36908","type":"HCPCS"}],"standard_charges":[{"gross_charge":38955.0,"discounted_cash":23373.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36908 DIALYSIS CENTRAL SEGMENT STENT AND BALLOON - LT","code_information":[{"code":"3611308","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36908","type":"HCPCS"}],"standard_charges":[{"gross_charge":38955.0,"discounted_cash":23373.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36909 DIALYSIS CIRCUIT IMAGING & EMBO/OCCLUSION - RT","code_information":[{"code":"3611309","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":19428.0,"discounted_cash":11656.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36909 DIALYSIS CIRCUIT IMAGING & EMBO/OCCLUSION - LT","code_information":[{"code":"3611310","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":19428.0,"discounted_cash":11656.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37246 VISCERAL, AORTIC OR BRACHIOCEPHALIC BALLOON, OPEN OR PERQ 1ST ARTERY-RT","code_information":[{"code":"3611311","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":19272.0,"discounted_cash":11563.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37246 VISCERAL, AORTIC OR BRACHIOCEPHALIC BALLOON, OPEN OR PERQ 1ST ARTERY-LT","code_information":[{"code":"3611312","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":19272.0,"discounted_cash":11563.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37247 VISCERAL BALLOON, OPEN OR PERQ EA ADDL ARTERY - RT","code_information":[{"code":"3611313","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":7907.0,"discounted_cash":4744.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37247 VISCERAL BALLOON, OPEN OR PERQ EA ADDL ARTERY - LT","code_information":[{"code":"3611314","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37247","type":"HCPCS"}],"standard_charges":[{"gross_charge":7907.0,"discounted_cash":4744.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37248 VISCERAL BALLOON, OPEN OR PERQ 1ST VEIN - RT","code_information":[{"code":"3611315","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":19211.0,"discounted_cash":11526.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37248 VISCERAL BALLOON, OPEN OR PERQ 1ST VEIN - LT","code_information":[{"code":"3611316","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":19211.0,"discounted_cash":11526.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37249 VISCERAL BALLOON, OPEN OR PERQ EA ADDL VEIN- RT","code_information":[{"code":"3611317","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":7878.0,"discounted_cash":4726.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37249 VISCERAL BALLOON, OPEN OR PERQ EA ADDL VEIN- LT","code_information":[{"code":"3611318","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":7878.0,"discounted_cash":4726.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 62320 EPIDURAL NJX, CERV/THORACIC W/O IMAGING","code_information":[{"code":"3611319","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":6224.0,"discounted_cash":3734.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62321 EPIDURAL NJX,  CERV/THORACIC, WITH IMAGING","code_information":[{"code":"3611320","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":8649.0,"discounted_cash":5189.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62322 EPIDURAL NJX, LUMBAR/SACRAL W/O IMAGING","code_information":[{"code":"3611321","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2685.0,"discounted_cash":1611.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62323 EPIDURAL NJX, LUMBAR/SACRAL WITH IMAGING","code_information":[{"code":"3611322","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":3370.0,"discounted_cash":2022.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62324 EPIDURAL INFUSION, CERVICAL OR THORACIC - NO IMAGING","code_information":[{"code":"3611323","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":5925.0,"discounted_cash":3555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62325 EPIDURAL INFUSION, CERVICAL OR THORACIC - WITH IMAGING","code_information":[{"code":"3611324","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62325","type":"HCPCS"}],"standard_charges":[{"gross_charge":9468.0,"discounted_cash":5680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62326 EPIDURAL INFUSION, LUMBAR/SACRAL - NO IMAGING","code_information":[{"code":"3611325","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":5925.0,"discounted_cash":3555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62327 EPIDURAL INFUSION, LUMBAR/SACRAL - WITH IMAGING","code_information":[{"code":"3611326","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":9468.0,"discounted_cash":5680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93590 PERC PARAVALVULAR LEAK, 1ST OCCLUSION DEVICE, MITRAL VALUE","code_information":[{"code":"3611327","type":"CDM"},{"code":"0361","type":"RC"},{"code":"93590","type":"HCPCS"}],"standard_charges":[{"gross_charge":59434.0,"discounted_cash":35660.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93591 PERC PARAVALVULAR LEAK, 1ST OCCLUSION DEVICE, AORTIC VALUE","code_information":[{"code":"3611328","type":"CDM"},{"code":"0361","type":"RC"},{"code":"93591","type":"HCPCS"}],"standard_charges":[{"gross_charge":58944.0,"discounted_cash":35366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93592 PERC PARAVALVULAR LEAK, EACH ADDL  OCCLUSION DEVICE","code_information":[{"code":"3611329","type":"CDM"},{"code":"0361","type":"RC"},{"code":"93592","type":"HCPCS"}],"standard_charges":[{"gross_charge":58944.0,"discounted_cash":35366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33406 REPLACE AORTIC VALVE-OPEN- W/ BYPASS;ALLOGRAFT VALVE","code_information":[{"code":"3611330","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33406","type":"HCPCS"}],"standard_charges":[{"gross_charge":11683.0,"discounted_cash":7009.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33410 REPLACE AORTIC VALVE-OPEN- W/ BYPASS;STENTLESS VALVE","code_information":[{"code":"3611331","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33410","type":"HCPCS"}],"standard_charges":[{"gross_charge":10312.0,"discounted_cash":6187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33340 PERC TRANSCATH CLOS LT ATRIAL APP W IMPL","code_information":[{"code":"3611333","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33340","type":"HCPCS"}],"standard_charges":[{"gross_charge":82929.0,"discounted_cash":49757.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 58674 LAPAROSCPIC ABLATION,UTERINE FIBROIDS W/US GUID & RF","code_information":[{"code":"3611334","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58674","type":"HCPCS"}],"standard_charges":[{"gross_charge":24996.0,"discounted_cash":14997.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 19020 MASTO BREAST EXPL/DRN ABS DEEP RT","code_information":[{"code":"3611350","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":7273.0,"discounted_cash":4363.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 19020 MASTO BREAST EXPL/DRN ABS DEEP LT","code_information":[{"code":"3611351","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":7273.0,"discounted_cash":4363.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 41115 EXCISION OF LINGUAL FRENUM (FRENECTOMY)","code_information":[{"code":"3611352","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":2717.0,"discounted_cash":1630.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34701 EVR DPLMNT AORTA-AORTIC ENDOGRFT OTHR THAN RUPTR","code_information":[{"code":"3611355","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34701","type":"HCPCS"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":8565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34702 EVR DPLMNT AORTA-AORTIC ENDOGRFT INCL RUPTR","code_information":[{"code":"3611356","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34702","type":"HCPCS"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":8565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34703 EVR DPLMNT AORTA-UNI-ILIAC ENDOGRFT OTHR THN RUPTR","code_information":[{"code":"3611357","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34703","type":"HCPCS"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":8565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34704 EVR DPLMNT AORTA-UNI-ILIAC ENDOGRFT INCL RUPTR","code_information":[{"code":"3611358","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34704","type":"HCPCS"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":8565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34705 EVR DPLMNT AORTA-BI-ILIAC ENDOGRFT OTHR THAN RUPTR","code_information":[{"code":"3611359","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34705","type":"HCPCS"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":8565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34706 EVR DPLMNT AORTA-BI-ILIAC ENDOGRFT INCL RUPTR","code_information":[{"code":"3611360","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34706","type":"HCPCS"}],"standard_charges":[{"gross_charge":14276.0,"discounted_cash":8565.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34707 EVR DPLMNT ILIO-ILIAC TUBE ENDOGRFT OTHR THN RUPTR","code_information":[{"code":"3611361","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34707","type":"HCPCS"}],"standard_charges":[{"gross_charge":14543.0,"discounted_cash":8725.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34708 EVR DPLMNT ILIO-ILIAC TUBE ENDOGRFT INCL RUPTR","code_information":[{"code":"3611362","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34708","type":"HCPCS"}],"standard_charges":[{"gross_charge":14543.0,"discounted_cash":8725.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34710 DELAYED PLCMNT EXTNS PROSTHS FOR EVR 1ST VSL","code_information":[{"code":"3611363","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34710","type":"HCPCS"}],"standard_charges":[{"gross_charge":7267.0,"discounted_cash":4360.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36465 INJ NONCMPND SCLEROSANT SNGL INCOMPTNT VEIN","code_information":[{"code":"3611365","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36465","type":"HCPCS"}],"standard_charges":[{"gross_charge":4400.0,"discounted_cash":2640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36466 INJ NONCMPND SCLEROSANT MULTI INCOMPTNT VEINS","code_information":[{"code":"3611366","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36466","type":"HCPCS"}],"standard_charges":[{"gross_charge":4400.0,"discounted_cash":2640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36468 INJ SCLEROSCANT FOR SPIDER VEINS, LIMB OR TRUNK","code_information":[{"code":"3611367","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36468","type":"HCPCS"}],"standard_charges":[{"gross_charge":4400.0,"discounted_cash":2640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36482 ENDOVEN ABLTN THRPY CHEM ADHESIVE 1ST VEIN INCLUSIVE","code_information":[{"code":"3611368","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36482","type":"HCPCS"}],"standard_charges":[{"gross_charge":11767.0,"discounted_cash":7060.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38222 DIAGNOSTIC BONE MARROW BX & ASPIR","code_information":[{"code":"3611369","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3207.0,"discounted_cash":1924.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36471 INJ SCLEROSING SOL MULTIPLE INCOMP V OTHER THAN TELANGIECTASIA","code_information":[{"code":"3611373","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36471","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.0,"discounted_cash":1107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34709 PLAC EXT PROSTH ILIAC ART/PROX RENL ART EVR INFRA AA/ILIAC ANEURSYM","code_information":[{"code":"3611374","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34709","type":"HCPCS"}],"standard_charges":[{"gross_charge":7267.0,"discounted_cash":4360.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 34711 PLAC EXT PROS ILAC ART/PROX RENL ART EVR INFRA AA/ILIAC ANEUR EA ADD","code_information":[{"code":"3611375","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34711","type":"HCPCS"}],"standard_charges":[{"gross_charge":7267.0,"discounted_cash":4360.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37765 STAB PHLEBECTOMY OF VARICOSE VEINS; 1 EXT 10-20 STABS INCS","code_information":[{"code":"3611386","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37765","type":"HCPCS"}],"standard_charges":[{"gross_charge":9721.0,"discounted_cash":5832.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36410 VENIPUNCTURE, AGE 3 OR >, FOR DX/TX PURPOSES (NOT ROUTINE VENIPUNCTURE)","code_information":[{"code":"3611391","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 52310 CYSTOURETHROSCOPY W/ FB/CALCULUS/STENT REMOVAL","code_information":[{"code":"3611418","type":"CDM"},{"code":"0361","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":7573.0,"discounted_cash":4543.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62252 REPROGRAM CEREBROSPINAL SHUNT","code_information":[{"code":"3611419","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62252","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":445.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10021 FINE NEEDLE ASPIRATION BX, W/O IMAGING GUIDE; FIRST LESION","code_information":[{"code":"3611421","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":406.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10004 FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL","code_information":[{"code":"3611422","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36572 PICC LINE INSERTION W/O SUBQ PORT < 5 YRS /INCL IMAGING","code_information":[{"code":"3611425","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":10900.0,"discounted_cash":6540.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36573 PICC LINE INSERTIONW/O SUBQ PORT 5 YR/> / INCL IMAGING","code_information":[{"code":"3611429","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":7183.0,"discounted_cash":4309.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43762 REPLACE PERC G TUBE, NO TRACT REVISION, NO IMAGING","code_information":[{"code":"3611433","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":551.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43763 REPLACE PERC G TUBE WITH TRACT REVISION, NO IMAGING","code_information":[{"code":"3611434","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1057.0,"discounted_cash":634.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"3611439","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11104 PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"3611440","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11106 INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"3611441","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11103 TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"3611442","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":300.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11105 PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"3611443","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":300.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11107 INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"3611444","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":300.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37766 STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS","code_information":[{"code":"3611445","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37766","type":"HCPCS"}],"standard_charges":[{"gross_charge":10365.0,"discounted_cash":6219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31645 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH THERAPEUTIC ASPIRATION, INITIAL","code_information":[{"code":"3611446","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31645","type":"HCPCS"}],"standard_charges":[{"gross_charge":3930.0,"discounted_cash":2358.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62328 DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"3611453","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1692.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62329 THERAPEUTIC LUMBAR PUNCTURE FOR DRAINAGE CSF W/FLUOR OR CT","code_information":[{"code":"3611454","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":3483.0,"discounted_cash":2089.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33016 PERICARDIOCENTESIS, INCLUDING IMAGING GUIDANCE WHEN PERFORMED","code_information":[{"code":"3611455","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":4471.0,"discounted_cash":2682.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33017 PERICARDIAL DRAIN W/INSERT OF INDWLLNG CATH INCL IMAG GUID 6>","code_information":[{"code":"3611652","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33017","type":"HCPCS"}],"standard_charges":[{"gross_charge":4398.0,"discounted_cash":2638.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32408 BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE","code_information":[{"code":"3611662","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":1911.0,"discounted_cash":1146.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33995 INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY","code_information":[{"code":"3611663","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33995","type":"HCPCS"}],"standard_charges":[{"gross_charge":9391.0,"discounted_cash":5634.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 19499 UNLISTED PROCEDURE BREAST","code_information":[{"code":"3611679","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19499","type":"HCPCS"}],"standard_charges":[{"gross_charge":3813.0,"discounted_cash":2287.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9780 INSERT CV CATH INFERIOR & SUPERIOR, INC IMAGE GUIDE","code_information":[{"code":"3611687","type":"CDM"},{"code":"0361","type":"RC"},{"code":"C9780","type":"HCPCS"}],"standard_charges":[{"gross_charge":24832.0,"discounted_cash":14899.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0673T ABLATION BENIGN THYROID NODULE PERQ LASER W/IMG GDN","code_information":[{"code":"3611691","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0673T","type":"HCPCS"}],"standard_charges":[{"gross_charge":4425.0,"discounted_cash":2655.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38500 BIOPSY OR EXC LYMPH NODES OPEN SPRF","code_information":[{"code":"3611745","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38500","type":"HCPCS"}],"standard_charges":[{"gross_charge":6388.0,"discounted_cash":3832.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANESTHESIA SERVICES, 0-30 MINS","code_information":[{"code":"3700001","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2984.0,"discounted_cash":1790.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANESTHESIA SERVICES, EA ADD'L 30 MIN","code_information":[{"code":"3700002","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99151 MODERATE SEDATION, SAME QHP, 1ST 15 MIN, <5 YRS","code_information":[{"code":"3700017","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99152 MODERATE SEDATION, SAME QHP, 1ST 15 MIN, 5/>YRS","code_information":[{"code":"3700018","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":346.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99153 MODERATE SEDATION, SAME QHP,  EACH ADDL 15 MIN","code_information":[{"code":"3700019","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99155 MODERATE SEDATION, OTHER QHP, 1ST 15 MIN, <5 YRS","code_information":[{"code":"3700020","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99156 MODERATE SEDATION, OTHER QHP, 1ST 15 MIN, 5/>YRS","code_information":[{"code":"3700021","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99157 MODERATE SEDATION, OTHER QHP, EACH ADDL 15 MIN","code_information":[{"code":"3700022","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.0,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99152/G0500 MODERATE SEDATION-15 MIN GASTROINTESTINAL ENDO SVC >5","code_information":[{"code":"3700023","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":346.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GENERAL ANESTHESIA 1ST 30 MIN","code_information":[{"code":"3700030","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.0,"discounted_cash":1675.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REGIONAL ANESTH 1ST 30 MIN","code_information":[{"code":"3700031","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":838.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MAC ANESTH 1ST 30 MIN","code_information":[{"code":"3700032","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700032","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"discounted_cash":1424.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GENERAL ANESTHESIA EA ADD'L 30 MIN","code_information":[{"code":"3700033","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700033","type":"HCPCS"}],"standard_charges":[{"gross_charge":1815.0,"discounted_cash":1089.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REGIONAL ANESTH EA ADD'L 30 MIN","code_information":[{"code":"3700034","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700034","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":544.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MAC ANESTH EA ADD'L 30 MIN","code_information":[{"code":"3700035","type":"CDM"},{"code":"0370","type":"RC"},{"code":"3700035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1544.0,"discounted_cash":926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BLOOD (WHOLE), FOR TRANSFUSION, EACH UNIT","code_information":[{"code":"3900001","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2038.0,"discounted_cash":1222.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRYOPRECIPITATE, EACH UNIT","code_information":[{"code":"3900002","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FRESH FROZEN PLASMA SGL DONOR FROZEN W/IN 8 HRS OF COLLECT EA UNIT","code_information":[{"code":"3900003","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, WASHED, EACH UNIT","code_information":[{"code":"3900004","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS, PHERESIS, EACH UNIT","code_information":[{"code":"3900005","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":4918.0,"discounted_cash":2950.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT","code_information":[{"code":"3900006","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1555.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, DEGLYCEROLIZED, EA UNIT","code_information":[{"code":"3900007","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9039","type":"HCPCS"}],"standard_charges":[{"gross_charge":2081.0,"discounted_cash":1248.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLASMA, CRYOPRECIPITATE REDUCED, EACH UNIT","code_information":[{"code":"3900008","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9044","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS HLA-MATCH LEUKOCYTES REDUCED APHERESIS/PHERESIS, EA UNIT","code_information":[{"code":"3900009","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":4955.0,"discounted_cash":2973.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS LEUKOCYTES REDUCED CMV NEG, IRRADIATED, EA UNIT","code_information":[{"code":"3900010","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9058","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.0,"discounted_cash":646.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FRESH FROZN PLASMA BETWEEN 8-24 HOURS OF COLLECTION, EACH UNIT","code_information":[{"code":"3900011","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":320.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BLOOD, SPLIT UNIT","code_information":[{"code":"3900012","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT","code_information":[{"code":"3900013","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":492.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, EACH UNIT","code_information":[{"code":"3900014","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":685.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT","code_information":[{"code":"3900015","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9033","type":"HCPCS"}],"standard_charges":[{"gross_charge":5165.0,"discounted_cash":3099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT","code_information":[{"code":"3900016","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":1476.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, IRRADIATED, EACH UNIT","code_information":[{"code":"3900017","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9038","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT","code_information":[{"code":"3900018","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WHOLE BLOOD OR RED BLOOD CELLS LEUKOCYTE REDUCED CMV-NEG, EA UNIT","code_information":[{"code":"3900019","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9051","type":"HCPCS"}],"standard_charges":[{"gross_charge":1423.0,"discounted_cash":853.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS LEUKOCYTE REDUCED CMV-NEG, APHERESIS/PHERESIS, EA UNIT","code_information":[{"code":"3900020","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2584.0,"discounted_cash":1550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS, LEUKOCYTES REDUCED, EACH UNIT","code_information":[{"code":"3900021","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9031","type":"HCPCS"}],"standard_charges":[{"gross_charge":2518.0,"discounted_cash":1510.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BLOOD (WHOLE), FOR TRANSFUSION, EACH UNIT","code_information":[{"code":"3900028","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BLOOD (WHOLE), FOR TRANSFUSION, EACH UNIT","code_information":[{"code":"3900030","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1015.0,"discounted_cash":609.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FRESH FROZEN PLASMA SGL DONOR FROZEN W/IN 8 HRS OF COLLECT EA UNIT","code_information":[{"code":"3900033","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FRESH FROZEN PLASMA SGL DONOR FROZEN W/IN 8 HRS OF COLLECT EA UNIT","code_information":[{"code":"3900034","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, WASHED, EACH UNIT","code_information":[{"code":"3900035","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.0,"discounted_cash":939.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, WASHED, EACH UNIT","code_information":[{"code":"3900036","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, DEGLYCEROLIZED, EA UNIT","code_information":[{"code":"3900037","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9039","type":"HCPCS"}],"standard_charges":[{"gross_charge":1885.0,"discounted_cash":1131.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT","code_information":[{"code":"3900038","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":826.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT","code_information":[{"code":"3900039","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":899.0,"discounted_cash":539.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, EACH UNIT","code_information":[{"code":"3900040","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":685.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT","code_information":[{"code":"3900041","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":4749.0,"discounted_cash":2849.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT","code_information":[{"code":"3900042","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1637.0,"discounted_cash":982.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC WHOLE BLOOD OR RED BLOOD CELLS LEUKOCYTE REDUCED CMV-NEG EA UNIT","code_information":[{"code":"3900043","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9051","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS LEUKOCYTE REDUCED CMV-NEG, APHERESIS/PHERESIS, EA UNIT","code_information":[{"code":"3900045","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9055","type":"HCPCS"}],"standard_charges":[{"gross_charge":5300.0,"discounted_cash":3180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PLATELETS PHERESIS PATHOGEN REDUCED EA UNIT","code_information":[{"code":"3900058","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":4749.0,"discounted_cash":2849.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36456 PRTL EXCH TRANSFUS,BLOOD/PLASMA/CRYSTL,NEWBORN","code_information":[{"code":"3900059","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36456","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.0,"discounted_cash":700.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0279 DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL -  RT","code_information":[{"code":"4010022","type":"CDM"},{"code":"0401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0279 DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL -  LT","code_information":[{"code":"4010023","type":"CDM"},{"code":"0401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0279 DIGITAL BREAST TOMOSYNTHESIS; BILATERAL","code_information":[{"code":"4010024","type":"CDM"},{"code":"0401","type":"RC"},{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SCREENING  DIGITAL BREAST TOMOSYNTHESIS","code_information":[{"code":"4010025","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":47.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77065 MAMMOGRAM,DIAGNOSTIC,+/- CAD,UNI-RT","code_information":[{"code":"4010026","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":452.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 77065 MAMMOGRAM,DIAGNOSTIC,+/- CAD,UNI-LT","code_information":[{"code":"4010027","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":452.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 77065 MAMMOGRAM,DIAGNOSTIC,+/- CAD IMPLANT,UNI-RT","code_information":[{"code":"4010028","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":544.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 77065 MAMMOGRAM,DIAGNOSTIC,+/- CAD IMPLANT,UNI-LT","code_information":[{"code":"4010029","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":544.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 77065 MAMMOGRAM,(SCREEN TO DIAGNOSTIC) +/- CAD,UNI","code_information":[{"code":"4010030","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77066 MAMMOGRAM,DIAGNOSTIC,+/- CAD,BILATERAL","code_information":[{"code":"4010031","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77066 MAMMOGRAM,DIAGNOSTIC,+/- CAD,IMPLANTS,BILATERAL","code_information":[{"code":"4010032","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":1213.0,"discounted_cash":727.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77066 MAMMOGRAM,(SCREEN TO DIAGNOSTIC),+/- CAD,BILAT","code_information":[{"code":"4010033","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":524.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77067 MAMMOGRAM SCREENING,+/- CAD,BILATERAL","code_information":[{"code":"4010035","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77067 MAMMOGRAM SCRN,+/- CAD,UNI-LT","code_information":[{"code":"4010038","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 77067 MAMMOGRAM SCRN,+/- CAD,UNI-RT","code_information":[{"code":"4010039","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 77067 MAMMOGRAM SCRN,W/IMPLANTS,+/- CAD,BILAT","code_information":[{"code":"4010040","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":812.0,"discounted_cash":487.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77067 MAMMOGRAM SCRN,W/IMPLANTS,+/- CAD,UNI-LT","code_information":[{"code":"4010041","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77067 MAMMOGRAM SCRN,W/IMPLANTS,+/- CAD,UNI-RT","code_information":[{"code":"4010042","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76810 US PREG UTRS >14 WKS EA ADD'L FETHC US","code_information":[{"code":"4020001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":599.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76811 US PREG UTERHC US  FETAL & MAT EVAL SINGLE","code_information":[{"code":"4020002","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76811","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1011.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76812 US PREG UTERHC US  FETAL & MAT EVAL EA ADD'L","code_information":[{"code":"4020003","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76812","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":556.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76815 US PREGNANT UTERUS LIMITED 1/>FETUSES","code_information":[{"code":"4020004","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":347.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US  PREG UTERHC US  F/U OR REPEAT, SINGLE","code_information":[{"code":"4020006","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1311.0,"discounted_cash":786.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US  PREG UTERHC US  F/U OR REPEAT, EA FETHC US","code_information":[{"code":"4020007","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":396.0,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 76817 US PREG UTERHC US TRANSVAGINAL","code_information":[{"code":"4020008","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1084.0,"discounted_cash":650.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US  PRG UT 1ST TRI TRNSLC,SNG/1ST GEST","code_information":[{"code":"4020012","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":604.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US  PRG UT 1ST TRI TRNSLC,EA ACC GEST","code_information":[{"code":"4020013","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76946 US GUIDE  AMNIOCENTESIS","code_information":[{"code":"4020016","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76946","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.0,"discounted_cash":1042.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75989 US GUIDE PERC DRAIN ABSCESS W/PLACE CATH-","code_information":[{"code":"4020017","type":"CDM"},{"code":"0402","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":2494.0,"discounted_cash":1496.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76506 US ENCEPHALOGRAPY","code_information":[{"code":"4020018","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1229.0,"discounted_cash":737.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76536 US  SOFT TISSUE HEAD/NECK","code_information":[{"code":"4020019","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1534.0,"discounted_cash":920.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76604 US CHEST INCLUDES MEDIASTINUM","code_information":[{"code":"4020020","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":836.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76700 US ABDOMEN COMPLETE","code_information":[{"code":"4020024","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.0,"discounted_cash":1345.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76705 US ABDOMEN LIMITED LEVEL I","code_information":[{"code":"4020025","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":918.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US  ABDOMEN LIMITED, LEVEL II","code_information":[{"code":"4020026","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1912.0,"discounted_cash":1147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US  ABDOMEN LIMITED, LEVEL III","code_information":[{"code":"4020027","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":2390.0,"discounted_cash":1434.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76770 US RETROPERITONEAL COMPLETE","code_information":[{"code":"4020028","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":984.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76775 US RETROPERITONEAL LIMITED","code_information":[{"code":"4020029","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":841.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76776 US TRANSPLANTED,KIDNEY","code_information":[{"code":"4020030","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2009.0,"discounted_cash":1205.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76800 US SPINAL CANAL AND CONTENTS","code_information":[{"code":"4020031","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1606.0,"discounted_cash":963.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76801 US PREG UTERHC US  1ST TRIMESTER SINGLE","code_information":[{"code":"4020032","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1202.0,"discounted_cash":721.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76802 US PREG UTERHC US  1ST TRIMETER ADD'L FETHC US","code_information":[{"code":"4020033","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":523.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76805 US  PREG UTRS >14 WKS SGL FETS & MOM EVA","code_information":[{"code":"4020034","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1890.0,"discounted_cash":1134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76818 US  FETAL BIOPHYSICAL PROFILE W/ NST","code_information":[{"code":"4020035","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1532.0,"discounted_cash":919.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76818 US FETAL BIOPHYS PROFILE W/ NST, EA ADDL","code_information":[{"code":"4020036","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":461.4,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 76819 US FETAL BIOPHYSICAL PROFILE W/O NST","code_information":[{"code":"4020037","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1212.0,"discounted_cash":727.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76819 US FETAL BIOPHYS PROFILE W/O NST, EA ADD","code_information":[{"code":"4020038","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 76820 US DOPPLER VELOCIMETRY,FETAL;UMBILICAL ART","code_information":[{"code":"4020039","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":687.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76821 US DOPPLER VELOCIMETRY,FETAL;MID CEREB ART","code_information":[{"code":"4020040","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76821","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":715.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76825 US ECHOCARDIOGRAM FETAL CVS","code_information":[{"code":"4020041","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76825","type":"HCPCS"}],"standard_charges":[{"gross_charge":2228.0,"discounted_cash":1336.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76826 US ECHOCARDIO FETAL CVS, F/U OR REPEAT","code_information":[{"code":"4020042","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76826","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.0,"discounted_cash":589.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76827 US DOPPLER ECHO FETAL","code_information":[{"code":"4020043","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76827","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":873.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76828 US DOPPLER ECHO FETAL,F/U OR REPEAT","code_information":[{"code":"4020044","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76828","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76830 US TRANSVAGINAL","code_information":[{"code":"4020045","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1335.0,"discounted_cash":801.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76831 US SALINE INFHC US ION SIS COLOR FLOW DOPLER","code_information":[{"code":"4020046","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76831","type":"HCPCS"}],"standard_charges":[{"gross_charge":1845.0,"discounted_cash":1107.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76856 US PELVIS (NON-OBSTETRIC) COMPLETE","code_information":[{"code":"4020047","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1703.0,"discounted_cash":1021.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76857 US PELVIS (NON-OB), LIMITED OR FOLLOWUP","code_information":[{"code":"4020048","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.0,"discounted_cash":715.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76870 US SCROTUM AND CONTENTS","code_information":[{"code":"4020049","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1593.0,"discounted_cash":955.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76872 US TRANSRECTAL","code_information":[{"code":"4020050","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":2009.0,"discounted_cash":1205.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76873 US TRANSRECT, PROS VOL, BRACHY PLAN-FAC","code_information":[{"code":"4020051","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76873","type":"HCPCS"}],"standard_charges":[{"gross_charge":1781.0,"discounted_cash":1068.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76885 US INFANT HIPS-DYNAMIC","code_information":[{"code":"4020055","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76886 US INFANT HIPS LIMITED STATIC","code_information":[{"code":"4020056","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76886","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":319.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76932 US GUIDE ENDOMYOCARDIAL BIOPSY","code_information":[{"code":"4020058","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76932","type":"HCPCS"}],"standard_charges":[{"gross_charge":2857.0,"discounted_cash":1714.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76936 US  COMPRESS REPAIR, ARTERIAL OR A-V","code_information":[{"code":"4020059","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76936","type":"HCPCS"}],"standard_charges":[{"gross_charge":1588.0,"discounted_cash":952.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76937 US  VASCULAR ACESS EVAL POTENTIAL SITES","code_information":[{"code":"4020060","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":556.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76942 US  GUIDANCE","code_information":[{"code":"4020062","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1951.0,"discounted_cash":1170.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76965 US GUIDE INTERSTITIAL RADIOELMT APPL-FAC","code_information":[{"code":"4020064","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76965","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.0,"discounted_cash":1450.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76975 US GASTROINTESTINAL ENDOSCOPIC","code_information":[{"code":"4020066","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":980.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ULTRASOUND GI ENDOSCOPIC  S&I","code_information":[{"code":"4020067","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76975","type":"HCPCS"}],"standard_charges":[{"gross_charge":2278.0,"discounted_cash":1366.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76998 US GUIDANCE  INTRAOPERATIVE","code_information":[{"code":"4020068","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":2456.0,"discounted_cash":1473.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ULTRASOUND UNLISTED  PROCEDURE DX/INTVENT","code_information":[{"code":"4020069","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76999","type":"HCPCS"}],"standard_charges":[{"gross_charge":927.0,"discounted_cash":556.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76706 US ABDOMINAL AORTA SCREEN STUDY FOR AAA","code_information":[{"code":"4020072","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1014.0,"discounted_cash":608.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US PRG UT 1ST TRI TRNSLC,EA ACC GEST","code_information":[{"code":"4020073","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76814","type":"HCPCS"}],"standard_charges":[{"gross_charge":505.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US PRG UT 1ST TRI TRNSLC,SNG/1ST GEST","code_information":[{"code":"4020074","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":604.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51798 BLADDER SCAN (URINE CAPACITY) NON-IMAGING","code_information":[{"code":"4020076","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":256.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76881 US EXTR NONVASC REALTIME COMPL - RT","code_information":[{"code":"4020077","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.0,"discounted_cash":944.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 76881 US EXTR NONVASC REALTIME COMPL - LT","code_information":[{"code":"4020078","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.0,"discounted_cash":944.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 76881 US EXTR NONVASC REALTIME COMPL - BLT","code_information":[{"code":"4020079","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":2358.0,"discounted_cash":1414.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 76882 US EXTR NONVASC REALTIME LIMITED - RT","code_information":[{"code":"4020080","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":577.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 76882 US EXTR NONVASC REALTIME LIMITED - LT","code_information":[{"code":"4020081","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":577.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 76882 US EXTR NONVASC REALTIME LIMITED - BLT","code_information":[{"code":"4020082","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.0,"discounted_cash":865.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD RT","code_information":[{"code":"4020084","type":"CDM"},{"code":"0402","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.0,"discounted_cash":3606.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD LT","code_information":[{"code":"4020085","type":"CDM"},{"code":"0402","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.0,"discounted_cash":3606.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD BLT","code_information":[{"code":"4020086","type":"CDM"},{"code":"0402","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":9016.0,"discounted_cash":5409.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 49405 US-GUIDED DRAINAGE VISCERAL","code_information":[{"code":"4020088","type":"CDM"},{"code":"0402","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":5002.0,"discounted_cash":3001.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49406 US-GUIDED DRN PERITONEAL/RETROPERITONEAL","code_information":[{"code":"4020089","type":"CDM"},{"code":"0402","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4805.0,"discounted_cash":2883.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49407 US-GUIDED DRN PERITONEAL/RETRO TR/TV","code_information":[{"code":"4020090","type":"CDM"},{"code":"0402","type":"RC"},{"code":"49407","type":"HCPCS"}],"standard_charges":[{"gross_charge":6702.0,"discounted_cash":4021.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10030 US-GUIDED DRAINAGE SOFT TISSUE PERC","code_information":[{"code":"4020091","type":"CDM"},{"code":"0402","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":4642.0,"discounted_cash":2785.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ROBOTIC SURGERY ULTRASOUND","code_information":[{"code":"4020092","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":5901.0,"discounted_cash":3540.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US BREAST UNILATERAL REAL TIME WITH IMAGE COMPLETE - RT","code_information":[{"code":"4020093","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC US BREAST UNILATERAL REAL TIME WITH IMAGE COMPLETE - LT","code_information":[{"code":"4020094","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC US BREAST BILATERAL REAL TIME WITH IMAGE COMPLETE","code_information":[{"code":"4020095","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":376.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC US BREAST UNILATERAL REAL TIME WITH IMAGE LIMITED - RT","code_information":[{"code":"4020096","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC US BREAST UNILATERAL REAL TIME WITH IMAGE LIMITED - LT","code_information":[{"code":"4020097","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC US BREAST BILATERAL REAL TIME WITH IMAGE LIMITED","code_information":[{"code":"4020098","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":376.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 10005 FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION","code_information":[{"code":"4020104","type":"CDM"},{"code":"0402","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1513.0,"discounted_cash":907.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10006 FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL","code_information":[{"code":"4020105","type":"CDM"},{"code":"0402","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93985 US  VESSEL MAPPING FOR HEMODIALYSIS ACCESS COMPLETE BLT","code_information":[{"code":"4020108","type":"CDM"},{"code":"0402","type":"RC"},{"code":"93985","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":486.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93986 US  VESSEL MAPPING FOR HEMODIALYSIS ACCESS COMPLETE UNI","code_information":[{"code":"4020109","type":"CDM"},{"code":"0402","type":"RC"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PET WB-MELANOMA CA-NONCOV INDIC","code_information":[{"code":"4040001","type":"CDM"},{"code":"0404","type":"RC"},{"code":"G0219","type":"HCPCS"}],"standard_charges":[{"gross_charge":14305.0,"discounted_cash":8583.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":13088.0,"discounted_cash":7852.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PET BRAIN IMAGING METABOLIC","code_information":[{"code":"4040002","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78608","type":"HCPCS"}],"standard_charges":[{"gross_charge":10881.0,"discounted_cash":6528.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":9958.0,"discounted_cash":5974.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PET DIAG BREAST CANCER INITIAL DX","code_information":[{"code":"4040003","type":"CDM"},{"code":"0404","type":"RC"},{"code":"G0252","type":"HCPCS"}],"standard_charges":[{"gross_charge":11900.0,"discounted_cash":7140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":8787.0,"discounted_cash":5272.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PET CT-LIMITED AREA CHEST HEAD/NECK","code_information":[{"code":"4040004","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78814","type":"HCPCS"}],"standard_charges":[{"gross_charge":10879.0,"discounted_cash":6527.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":8035.0,"discounted_cash":4821.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PET CT-SKULL BASE TO MID THIGH","code_information":[{"code":"4040005","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":12696.0,"discounted_cash":7617.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":9377.0,"discounted_cash":5626.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PET CT-WHOLE BODY","code_information":[{"code":"4040006","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":13880.0,"discounted_cash":8328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":10249.0,"discounted_cash":6149.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC PET MYOCARDIAL; METABOLIC EVALUATION","code_information":[{"code":"4040009","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78459","type":"HCPCS"}],"standard_charges":[{"gross_charge":9380.0,"discounted_cash":5628.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":8581.0,"discounted_cash":5148.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC  31720  CATHETER ASPIRATION, NASOTRACHEAL","code_information":[{"code":"4100001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CARDIOVASCULAR STRESS TEST-LIMITED","code_information":[{"code":"4100002","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.0,"discounted_cash":918.0,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC  94002  VENT & MANAGE INITIAL DAY","code_information":[{"code":"4100005","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94003  VENT  & MANAGE, EA SUBSQ DAY","code_information":[{"code":"4100008","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1500.0,"discounted_cash":900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94010 SPIROMETRY W/GRAPHIC RECORD","code_information":[{"code":"4100009","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.0,"discounted_cash":294.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94060 SPIROMETRY PRE/POST BROCHODILATOR W/GRPH","code_information":[{"code":"4100010","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1153.0,"discounted_cash":691.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94070 BRONCHIAL CHALLENGE","code_information":[{"code":"4100011","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1829.0,"discounted_cash":1097.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94150 VITAL CAPACITY, TOTAL","code_information":[{"code":"4100012","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BREATHING RESPONSE TO HYPOXIA","code_information":[{"code":"4100017","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94450","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.0,"discounted_cash":428.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94610  INTRAPULMONARY SURFACTANT ADM ENDO TUBE","code_information":[{"code":"4100018","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94610","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94621 CARDIOPULMONARY EXERCISE TESTING COMPLEX","code_information":[{"code":"4100020","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94621","type":"HCPCS"}],"standard_charges":[{"gross_charge":2466.0,"discounted_cash":1479.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94640 AIRWAY INHALATION TREATMENT INITIAL","code_information":[{"code":"4100021","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94640  MDI TREATMENT INITIAL","code_information":[{"code":"4100022","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94640 AIRWAY INHALATION TREATMENT SUBSQ","code_information":[{"code":"4100023","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","modifier_code":["76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC  94640  MDI TREATMENT SUBSEQUENT","code_information":[{"code":"4100024","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94642  AEROSAL INHAL PENTAMIDINE","code_information":[{"code":"4100025","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94644  CONT.INHALE TX WITH AEROSOL MED,1ST HR","code_information":[{"code":"4100026","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94645  CONT.INHALE TX WITH AEROSOL MED,EA ADD HR","code_information":[{"code":"4100027","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94645","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94660  CPAP/BIPAP INITIATION AND MGMT","code_information":[{"code":"4100028","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94664  DEMO/EVAL MED TX ONCE PER DAY","code_information":[{"code":"4100029","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94667  MANIPULATION CHEST WALL, INITIAL","code_information":[{"code":"4100030","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94667  ACAPELLA CHEST PERC INITIAL","code_information":[{"code":"4100031","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94668  MANIPULATION CHEST WALL, SUBSEQ","code_information":[{"code":"4100032","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94668  ACAPELLA CHEST PERC SUBSEQUENT","code_information":[{"code":"4100033","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94681 O2 UPTK EXP GAS ANLYS INC CO2 OP %O2","code_information":[{"code":"4100034","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94681","type":"HCPCS"}],"standard_charges":[{"gross_charge":1131.0,"discounted_cash":678.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94690 O2 UPTK EXP GAS ANALYSIS REST INDIRCT","code_information":[{"code":"4100035","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94690","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94761 PULSE OXIMETRY, MULTIPLE DETERM","code_information":[{"code":"4100037","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94762 PULSE OXIMETRY, CONTINUOUS (OVERNIGHT)","code_information":[{"code":"4100038","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":712.0,"discounted_cash":427.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CIRCADIAN RESP RECORD 12-24 HR; INF-FAC","code_information":[{"code":"4100040","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94772","type":"HCPCS"}],"standard_charges":[{"gross_charge":839.0,"discounted_cash":503.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  G0237  THERAP PROC INCRS RESP MUSCLE EA 15MIN 1","code_information":[{"code":"4100046","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  G0238  THERAP PROC RESP FUNCTION EA 15 MIN","code_information":[{"code":"4100047","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  G0239  THERPEUTIC EXERCISE,2 OR MORE","code_information":[{"code":"4100048","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94760 PULSE OXIMETRY SINGLE DETERM","code_information":[{"code":"4100054","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95992 PT CANALITH REPOSITIONING PROCEDURE(S), PER DAY","code_information":[{"code":"4100061","type":"CDM"},{"code":"0420","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":197.0,"discounted_cash":118.2,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC TISSUE OXYGENATION MONITORING","code_information":[{"code":"4100062","type":"CDM"},{"code":"0410","type":"RC"},{"code":"4100062","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC  94669  MECHANICAL CHEST WALL OSCILLATION (THERAPY VEST), PER SESSION","code_information":[{"code":"4100066","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NITRIC OXIDE CHALLENGE","code_information":[{"code":"4100071","type":"CDM"},{"code":"0410","type":"RC"},{"code":"4100071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":705.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94621 CARDIOPULMONARY EXERCISE TESTING","code_information":[{"code":"4100076","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94621","type":"HCPCS"}],"standard_charges":[{"gross_charge":2466.0,"discounted_cash":1479.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94621 CARDIOPULMONARY EXERCISE TESTING COMPLEX","code_information":[{"code":"4100077","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94621","type":"HCPCS"}],"standard_charges":[{"gross_charge":2466.0,"discounted_cash":1479.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94618 PULMONARY STRESS TESTING","code_information":[{"code":"4100078","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94618 PULMONARY EXERCISE CHALLENGE TEST, SIMPLE","code_information":[{"code":"4100079","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.0,"discounted_cash":470.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94617 EXERCISE TEST FOR BRONCHOSPASM","code_information":[{"code":"4100080","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94617","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.0,"discounted_cash":502.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94625 PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR","code_information":[{"code":"4100086","type":"CDM"},{"code":"0948","type":"RC"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94626 PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR","code_information":[{"code":"4100087","type":"CDM"},{"code":"0948","type":"RC"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.0,"discounted_cash":171.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0277 HYPERBARIC OXYGEN UNDER PRESSURE; FULL BODY CHAMBER; PER 30 MIN","code_information":[{"code":"4130001","type":"CDM"},{"code":"0413","type":"RC"},{"code":"G0277","type":"HCPCS"}],"standard_charges":[{"gross_charge":1731.0,"discounted_cash":1038.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97012 PT MECHANICAL TRACTION","code_information":[{"code":"4200020","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97014 / G0283 PT ELECTRICAL STIMULATION (UNATTEND)","code_information":[{"code":"4200021","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97022 PT WHIRLPOOL FLUIDOTHERAPY","code_information":[{"code":"4200023","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":62.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":104.0,"discounted_cash":62.4,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97028 PT ULTRAVIOLET","code_information":[{"code":"4200026","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97028","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":27.6,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97032 PT ELECTRICAL STIM (MANUAL), EA 15 MIN","code_information":[{"code":"4200027","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":86.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97033 PT IONTOPHORESIS, EA 15 MIN","code_information":[{"code":"4200028","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":86.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97035 PT ULTRASOUND EA 15 MIN","code_information":[{"code":"4200030","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97110 PT THERAPEUTIC EXERCISE, EA 15 MIN","code_information":[{"code":"4200032","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97112 PT NEUROMUSCULAR RE-EDUCATION, EA 15 MIN","code_information":[{"code":"4200035","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97113 PT AQUATIC THERAPY, EA 15 MIN","code_information":[{"code":"4200036","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97116 PT GAIT TRAINING, EA 15 MIN","code_information":[{"code":"4200037","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97140 PT MANUAL THERAPY, EA 15 MIN","code_information":[{"code":"4200039","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97150 PT GROUP THERAPY, PER SESSION","code_information":[{"code":"4200040","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":66.0,"discounted_cash":39.6,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97530 PT THERAPEUTIC ACTIVITIES,DIRECT,EA 15 M","code_information":[{"code":"4200041","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97535 PT SELF CARE/HOME MGMT TRAIN, EA 15 MIN","code_information":[{"code":"4200042","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97537 PT COMM/WORK REINTEGRATION, EA 15 MIN","code_information":[{"code":"4200043","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97542 PT WHEELCHAIR/PROPUL TRAINING, EA 15 MIN","code_information":[{"code":"4200044","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97545 PT WORK HARDENING/COND, INITIAL 2 HR","code_information":[{"code":"4200045","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":602.0,"discounted_cash":361.2,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":602.0,"discounted_cash":361.2,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97546 PT WORK HARDENING/COND, EA ADDL HR","code_information":[{"code":"4200046","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97546","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":127.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97597 PT SELECT DEBRIDEMENT FIRST 20 SQ CM OR <","code_information":[{"code":"4200047","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":187.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":313.0,"discounted_cash":187.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97598 PT SELECT DEBRIDEMENT EA ADD 20 SQ CM","code_information":[{"code":"4200048","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":121.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":203.0,"discounted_cash":121.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97750 PT PHYS PERFORMANCE TEST, EA 15 MN","code_information":[{"code":"4200052","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":177.0,"discounted_cash":106.2,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97760 PT INITIAL ORTH MAN/TRN U EX/L EX, TRK EA 15 MIN","code_information":[{"code":"4200057","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97761 PT INTIIAL PROSTH TRAIN UP/LW EXT EA 15 MIN","code_information":[{"code":"4200058","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 99499 PT IFSP DEVELOP/MTG ONSITE","code_information":[{"code":"4200060","type":"CDM"},{"code":"0420","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 99499 PT IFSP MEETING ONSITE PER 15 MIN","code_information":[{"code":"4200061","type":"CDM"},{"code":"0420","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97016 PT VASOPNEUMATIC DEVICES","code_information":[{"code":"4200071","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 29345 PT CAST APPL LONG LEG-RT","code_information":[{"code":"4200133","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29355 PT CAST APPL LONG LEG WALKING TYPE-RT","code_information":[{"code":"4200134","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29355","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":403.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29405 PT CAST APPL SHORT LEG-RT","code_information":[{"code":"4200135","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":297.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29345 PT CAST APPL LONG LEG-LT","code_information":[{"code":"4200141","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29355 PT CAST APPL LONG LEG WALKING TYPE-LT","code_information":[{"code":"4200142","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29355","type":"HCPCS"}],"standard_charges":[{"gross_charge":673.0,"discounted_cash":403.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29405 PT CAST APPL SHORT LEG-LT","code_information":[{"code":"4200143","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":495.0,"discounted_cash":297.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 97605 PT NEGATIVE PRESSURE WOUND TX <=50 SQ CM-UTILIZE DME","code_information":[{"code":"4200158","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":219.6,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97606 PT NEGATIVE PRESSURE WOUND TX >50 SQ CM-UTILIZE DME","code_information":[{"code":"4200159","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":376.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97161 PT EVALUATION, LOW COMPLEXITY","code_information":[{"code":"4200162","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":231.6,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97162 PT EVALUATION, MODERATE COMPLEXITY","code_information":[{"code":"4200165","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":247.2,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97163 PT EVALUATION, HIGH COMPLEXITY","code_information":[{"code":"4200168","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":278.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97164 PT RE-EVALUATION","code_information":[{"code":"4200171","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":160.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97763 PT ORTH PROS MAN/TRN U/L EXT TRK EA 15 MIN","code_information":[{"code":"4200180","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 29581 PT APPL MULTILAYER COMPRESS SYST LOWER LEG/ANKL/FT BLT","code_information":[{"code":"4200183","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","modifier_code":["GP","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29581 PT APPL MULTILAYER COMPRESS SYST LOWER LEG/ANKL/FT LT","code_information":[{"code":"4200184","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","modifier_code":["GP","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 29581 PT APPL MULTILAYER COMPRESS SYST LOWER LEG/ANKL/FT RT","code_information":[{"code":"4200185","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","modifier_code":["GP","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 29584 PT APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND/FNGR BLT","code_information":[{"code":"4200186","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["GP","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29584 PT APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND/FNGR LT","code_information":[{"code":"4200187","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["GP","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 29584 PT APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND/FNGR RT","code_information":[{"code":"4200188","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["GP","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 97530 PT EI INDV THRPY OFF-SITE EA 15 MIN","code_information":[{"code":"4200189","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97530 PT EI INDV THRPY ON-SITE EA 15 MIN","code_information":[{"code":"4200190","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 96112 PT DEVELOP TEST ADMIN PHYS/QHP 1ST HOUR","code_information":[{"code":"4200191","type":"CDM"},{"code":"0420","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 96113 PT DEVELOP TEST ADMIN PHYS/QHP EA ADDL 30 MIN","code_information":[{"code":"4200192","type":"CDM"},{"code":"0420","type":"RC"},{"code":"96113","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 96112 PT EI DEVELOP TEST ADMIN PHYS/QHP PER 15 MIN ON SITE","code_information":[{"code":"4200193","type":"CDM"},{"code":"0420","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 96112 PT EI DEVELOP TEST ADMIN PHYS/QHP PER 15 MIN OFF SITE","code_information":[{"code":"4200199","type":"CDM"},{"code":"0420","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 96110 PT DEVELOPMENTAL & BEHAVIORAL SCREEN W/TEST","code_information":[{"code":"4200208","type":"CDM"},{"code":"0420","type":"RC"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 20560 NEEDLE INSERTION W/O INJECTION(S) 1 OR 2 MUSCLE(S), DRY NEEDLING","code_information":[{"code":"4200209","type":"CDM"},{"code":"0940","type":"RC"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20561 NEEDLE INSERTION W/O INJECTION(S) 3 OR MORE MUSCLES, DRY NEEDLING","code_information":[{"code":"4200210","type":"CDM"},{"code":"0940","type":"RC"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90912 BIOFEEDBACK TRAIN, PERINEAL MUSCLES 1ST 15 MIN","code_information":[{"code":"4200211","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 90913 BIOFEEDBACK TRAIN, PERINEAL MUSCLES EA ADDL 15 MIN","code_information":[{"code":"4200212","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":42.6,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":71.0,"discounted_cash":42.6,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97610 ULTRASONIC MIST THERAPY","code_information":[{"code":"4200213","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97610","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":278.4,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 98975 PT RTM REMOTE THERAP MNTR 1ST SET UP AND PT EDU EQUP","code_information":[{"code":"4200215","type":"CDM"},{"code":"0420","type":"RC"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":235.2,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 98976 PT RTM REMOTE THERAP MNTR DEV SPLY W/REC RESPIR SYS EA 30D","code_information":[{"code":"4200216","type":"CDM"},{"code":"0420","type":"RC"},{"code":"98976","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":67.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 98977 PT RTM REMOTE THERAP MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30D","code_information":[{"code":"4200217","type":"CDM"},{"code":"0420","type":"RC"},{"code":"98977","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":67.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97550 PT CAREGIVER TRAINING STRATEGIES&TQ 1ST 30 MIN","code_information":[{"code":"4200230","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97551 PT CAREGIVER TRAINING STRATEGIES&TQ EA ADDL 15 MIN","code_information":[{"code":"4200231","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":70.0,"discounted_cash":42.0,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97552 PT GROUP CAREGIVER TRAINING STRATEGIES & TECHNIQUE","code_information":[{"code":"4200232","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97014 / G0283  OT ELECTRICAL STIMULATION (UNATTEND)","code_information":[{"code":"4300016","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97016 OT VASOPNEUMATIC DEVICES","code_information":[{"code":"4300017","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97018 OT PARAFFIN BATH","code_information":[{"code":"4300018","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97022 OT WHIRLPOOL/FLUIDOTHERAPY","code_information":[{"code":"4300019","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":62.4,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":104.0,"discounted_cash":62.4,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97032 OT  ELECTRICAL STIM (MANUAL), EA 15 MIN","code_information":[{"code":"4300021","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":86.4,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97033 OT IONTOPHORESIS, EA 15 MIN","code_information":[{"code":"4300022","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":86.4,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97035 OT ULTRASOUND, EA 15 MIN","code_information":[{"code":"4300024","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97110 OT THERAPEUTIC EXERCISE, EA 15 MIN","code_information":[{"code":"4300026","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97112 OT NEUROMUSCULAR RE-EDUCATION, EA 15 MIN","code_information":[{"code":"4300027","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97113 OT AQUATIC THERAPY, EA 15 MIN","code_information":[{"code":"4300028","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97140 OT MANUAL THERAPY, EA 15 MIN","code_information":[{"code":"4300031","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97150 OT GROUP THERAPY, PER SESSION","code_information":[{"code":"4300032","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":66.0,"discounted_cash":39.6,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97530 OT THERPEUTIC ACTIVITY, DIR EA 15 MIN","code_information":[{"code":"4300034","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97530 OT EI INDV THRPY ON-SITE EA 15 MIN","code_information":[{"code":"4300035","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97530 OT EI INDV THRPY OFF-SITE EA 15 MIN","code_information":[{"code":"4300036","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97533 OT SENSORY INTEGRATION,EA 15 MIN","code_information":[{"code":"4300038","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97535 OT SELF CARE/HOME MGMT TRAIN, EA 15 MIN","code_information":[{"code":"4300039","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97537 OT COMM/WORK REINTEGRATION, EA 15 MIN","code_information":[{"code":"4300040","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97537","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97542 OT WHEELCHAIR/PROPUL TRAINING, EA 15 MIN","code_information":[{"code":"4300041","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97545 OT WORK HARDENING/COND, INITIAL 2 HR","code_information":[{"code":"4300042","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97545","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":535.0,"discounted_cash":321.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97546 OT WORK HARDENING/COND, EA ADDL HR","code_information":[{"code":"4300043","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97546","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":109.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":183.0,"discounted_cash":109.8,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97750 OT PHYS PERFORMANCE TEST, EA 15 MN","code_information":[{"code":"4300047","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":177.0,"discounted_cash":106.2,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97755 OT ASSIST TECH ASSESSMENT EA 15 MIN","code_information":[{"code":"4300051","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97755","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.0,"discounted_cash":90.6,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 99499 OT IFSP DEVELOP/MTG ONSITE","code_information":[{"code":"4300057","type":"CDM"},{"code":"0430","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":138.6,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 99499 OT IFSP DEVELOP/MTG OFFSITE","code_information":[{"code":"4300058","type":"CDM"},{"code":"0430","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 99499 OT IFSP MEETING ONSITE PER 15 MIN","code_information":[{"code":"4300060","type":"CDM"},{"code":"0430","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":68.4,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 29065 OT CAST APPL SHOULDER TO HAND RT","code_information":[{"code":"4300078","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["RT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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) | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 29065 OT CAST APPL SHOULDER TO HAND LT","code_information":[{"code":"4300079","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["LT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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 GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 29075 OT CAST APPL ELBOW TO FINGER RT","code_information":[{"code":"4300080","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["RT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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) | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 29075 OT CAST APPL ELBOW TO FINGER LT","code_information":[{"code":"4300081","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["LT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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 GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 29085 OT CAST APPL HAND/FOREARM (GAUNTLET) RT","code_information":[{"code":"4300082","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":184.8,"setting":"both","modifier_code":["RT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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) | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 29085 OT CAST APPL HAND/FOREARM (GAUNTLET) LT","code_information":[{"code":"4300083","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":184.8,"setting":"both","modifier_code":["LT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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 GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97165 OT EVALUATION, LOW COMPLEXITY","code_information":[{"code":"4300131","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.0,"discounted_cash":231.6,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97166 OT EVALUATION, MODERATE COMPLEXITY","code_information":[{"code":"4300134","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":247.2,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97167 OT EVALUATION, HIGH COMPLEXITY","code_information":[{"code":"4300137","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":278.4,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97168 OT RE-EVALUATION","code_information":[{"code":"4300140","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":160.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97150 OT EI GROUP THERAPY, PER SESSION","code_information":[{"code":"4300146","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97760 OT INITIAL ORTH MAN/TRN U EX/L EX, TRK EA 15 MIN","code_information":[{"code":"4300147","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97761 OT INITIAL PROSTH TRAIN UP/ LW EXT EA 15 MIN","code_information":[{"code":"4300148","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97763 OT ORTH PROS MAN/TRN U/L EXT TRK EA 15 MIN","code_information":[{"code":"4300151","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 96112 OT DEVELOP TEST ADMIN PHYS/QHP 1ST HOUR","code_information":[{"code":"4300154","type":"CDM"},{"code":"0430","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 96113 OT DEVELOP TEST ADMIN PHYS/QHP EA ADDL 30 MIN","code_information":[{"code":"4300155","type":"CDM"},{"code":"0430","type":"RC"},{"code":"96113","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 96112 OT EI DEVELOP TEST ADMIN PHYS/QHP PER 15 MIN ON SITE","code_information":[{"code":"4300156","type":"CDM"},{"code":"0430","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 96112 OT EI DEVELOP TEST ADMIN PHYS/QHP PER 15 MIN OFF SITE","code_information":[{"code":"4300162","type":"CDM"},{"code":"0430","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 96110 OT DEVELOPMENTAL & BEHAVORIAL SCREEN W/TEST","code_information":[{"code":"4300169","type":"CDM"},{"code":"0430","type":"RC"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97129 THERAPEUTIC INTERVENTION FOCUS CONGNITIVE FUNCTION 1ST 15 MINUTES","code_information":[{"code":"4300170","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97130 THERAPEUTIC INTERVENTION FOCUS CONGNITIVE FUNCTION EA ADDL 15 MINUTES","code_information":[{"code":"4300171","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 29584 OT APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND/FNGR BLT","code_information":[{"code":"4300172","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["GO","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29584 OT APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND/FNGR LT","code_information":[{"code":"4300173","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["GO","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 29584 OT APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND/FNGR RT","code_information":[{"code":"4300174","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","modifier_code":["GO","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 29581 OT APPL MULTILAYER COMPRESS SYST LOWER LEG/ANKL/FT BLT","code_information":[{"code":"4300175","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","modifier_code":["GO","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29581 OT APPL MULTILAYER COMPRESS SYST LOWER LEG/ANKL/FT LT","code_information":[{"code":"4300176","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","modifier_code":["GO","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 29581 OT APPL MULTILAYER COMPRESS SYST LOWER LEG/ANKL/FT RT","code_information":[{"code":"4300177","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","modifier_code":["GO","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 29580 STRAPPING,UNNA BOOT LT","code_information":[{"code":"4300178","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":229.2,"setting":"both","modifier_code":["GO","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 29580 STRAPPING,UNNA BOOT RT","code_information":[{"code":"4300179","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":229.2,"setting":"both","modifier_code":["GO","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 29580 STRAPPING,UNNA BOOT BLT","code_information":[{"code":"4300180","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","modifier_code":["GO","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier 50: Bilateral Procedure"}]},{"description":"HC 95992 OT CANALITH REPOSITIONING PROCEDURE(S), PER DAY","code_information":[{"code":"4300182","type":"CDM"},{"code":"0430","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":197.0,"discounted_cash":118.2,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 98975 OT RTM REMOTE THERAP MNTR 1ST SET UP AND PT EDU EQUP","code_information":[{"code":"4300183","type":"CDM"},{"code":"0430","type":"RC"},{"code":"98975","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":235.2,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 98976 OT RTM REMOTE THERAP MNTR DEV SPLY W/REC RESPIR SYS EA 30D","code_information":[{"code":"4300184","type":"CDM"},{"code":"0430","type":"RC"},{"code":"98976","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":67.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 98977 OT RTM REMOTE THERAP MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30D","code_information":[{"code":"4300185","type":"CDM"},{"code":"0430","type":"RC"},{"code":"98977","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":67.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 92526 OT TX SWALLOW/ORAL DYSFUNCT (EG FEEDING)","code_information":[{"code":"4300186","type":"CDM"},{"code":"0430","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97550 OT CAREGIVER TRAINING STRATEGIES&TQ 1ST 30 MIN","code_information":[{"code":"4300189","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97551 OT CAREGIVER TRAINING STRATEGIES&TQ EA ADDL 15 MIN","code_information":[{"code":"4300190","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":70.0,"discounted_cash":42.0,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 97552 OT GROUP CAREGIVER TRAINING STRATEGIES & TECHNIQUE","code_information":[{"code":"4300191","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 90912 BIOFEEDBACK TRAIN, PERINEAL MUSCLES 1ST 15 MIN","code_information":[{"code":"4300196","type":"CDM"},{"code":"0430","type":"RC"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 90913 BIOFEEDBACK TRAIN, PERINEAL MUSCLES EA ADDL 15 MIN","code_information":[{"code":"4300197","type":"CDM"},{"code":"0430","type":"RC"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"HC 92507 SPEECH-LANGUAGE THERAPY, INDIVIDUAL","code_information":[{"code":"4400004","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.0,"discounted_cash":256.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92507 SP EI INDIVIDUAL THRPY ONSITE,PER 15 MIN","code_information":[{"code":"4400005","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92507 SP EI  INDIVDUAL THRPY OFSITE,PER 15 MIN","code_information":[{"code":"4400006","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92508 SPEECH-LANG THERAPY, SESSION (2 OR >)","code_information":[{"code":"4400007","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":129.6,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92526 SP TX  SWALLOW/ORAL DYSFUNCT (EG DYSPHAG)","code_information":[{"code":"4400008","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92597 SP EVAL USE/FIT OF VOICE PROSTHETIC DEVICE","code_information":[{"code":"4400009","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92597","type":"HCPCS"}],"standard_charges":[{"gross_charge":670.0,"discounted_cash":402.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92606 SP THERAPEUTIC SERV USE NON-SPEECH DEVICE","code_information":[{"code":"4400010","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92606","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":330.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92607 SP EVAL FOR SPEECH GENERATING DEVICE-1ST HR","code_information":[{"code":"4400011","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":393.6,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92608 SP EVAL FOR SPEECH GENERATING DEVICE-EA ADD 30 MIN","code_information":[{"code":"4400012","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92608","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.0,"discounted_cash":183.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92609 SP SPEECH GENERATING DEVICE TRAINING","code_information":[{"code":"4400013","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92610 SP 250AL EVAL SWALLOWING FUNCTN","code_information":[{"code":"4400014","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":309.6,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92611 SP EVAL OF SWALLOWING WITH RADIOOPAQUE MAT","code_information":[{"code":"4400015","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":410.4,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92612 SP ENDOSCOPIC STUDY SWALLOW FUNCTN","code_information":[{"code":"4400017","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":375.6,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 96105 SP APHASIA ASSESS W/REPORT, PER HOUR","code_information":[{"code":"4400018","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":300.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 99499 SP IFSP DEVELOP/MTG ONSITE","code_information":[{"code":"4400025","type":"CDM"},{"code":"0440","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 99499 SP IFSP DEVELOP/MTG OFFSITE","code_information":[{"code":"4400026","type":"CDM"},{"code":"0440","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92520 SP ACOUSTIC/AERODYNAMIC EVAL","code_information":[{"code":"4400031","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92520","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":225.6,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC T1027 DEVELOP THER ON-SITE, PER 15 MIN","code_information":[{"code":"4400034","type":"CDM"},{"code":"0440","type":"RC"},{"code":"T1027","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.0,"discounted_cash":7.8,"setting":"both","modifier_code":["TL"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier TL: Early intervention/individualized family service plan (ifsp)"}]},{"description":"HC T1027 DEVELOP THER OFF-SITE, PER 15 MIN","code_information":[{"code":"4400035","type":"CDM"},{"code":"0440","type":"RC"},{"code":"T1027","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":10.8,"setting":"both","modifier_code":["TL"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier TL: Early intervention/individualized family service plan (ifsp)"}]},{"description":"HC T1027 DEVELOP THER GROUP, PER 15 MIN","code_information":[{"code":"4400036","type":"CDM"},{"code":"0440","type":"RC"},{"code":"T1027","type":"HCPCS"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.8,"setting":"both","modifier_code":["TL"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier TL: Early intervention/individualized family service plan (ifsp)"}]},{"description":"HC 99499 SP IFSP MEETING ONSITE PER 15 MIN","code_information":[{"code":"4400040","type":"CDM"},{"code":"0440","type":"RC"},{"code":"99499","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92521 SP EVALUATION OF SPEECH FLUENCY","code_information":[{"code":"4400077","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92522 SP EVALUATION OF SPEECH SOUND PRODUCTION","code_information":[{"code":"4400078","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92523 SP EVAL OF SPEECH SOUND PROD W LANG COMP/EXPRESSION","code_information":[{"code":"4400079","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92524 SP BEHAVIORAL AND QUALITATIVE ANALYSIS VOICE/RESONANCE","code_information":[{"code":"4400080","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":358.2,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 92521 SP EI EVALUATION OF SPEECH FLUENCY ONSITE","code_information":[{"code":"4400081","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92522 SP EI EVALUATION OF SPEECH SOUND PRODUCTION ONSITE","code_information":[{"code":"4400082","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92523 SP EI EVAL SP SOUND PROD W LANG COMP/EXPRESS ONSITE","code_information":[{"code":"4400083","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92524 SP EI BEHAVIORAL AND QUALIT ANALYS VOICE/RESONANCE ONSITE","code_information":[{"code":"4400084","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92521 SP EI EVAL/ASSESS OFFSITE OF SP FLUENCY 15 MIN","code_information":[{"code":"4400085","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":604.0,"discounted_cash":362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92522 SP EI EVAL/ASSESS OFFSITE OF SP SOUND PROD 15 MIN","code_information":[{"code":"4400086","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92523 SP EI EVAL/ASSESS OFFSITE SP SND W LANG COMP 15 MIN","code_information":[{"code":"4400087","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92524 SP EI  OFFSITE BEHAVRL/QUALIT ANALYS VOICE 15 MIN","code_information":[{"code":"4400088","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96125 COGNITIVE TEST BY HC PRO PER HOUR","code_information":[{"code":"4400101","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":280.2,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 96112 SP DEVELOP TEST ADMIN PHYS/QHP 1ST HOUR","code_information":[{"code":"4400119","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 96113 SP DEVELOP TEST ADMIN PHYS/QHP EA ADDL 30 MIN","code_information":[{"code":"4400120","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96113","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 96112 SP EI DEVELOP TEST ADMIN PHYS/QHP PER 15 MIN ON SITE","code_information":[{"code":"4400121","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 96112 SP EI DEVELOP TEST ADMIN PHYS/QHP PER 15 MIN OFF SITE","code_information":[{"code":"4400127","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 96112 DEVELOPMENT THERAPY EI PER 15 MIN ON SITE","code_information":[{"code":"4400131","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96112 DEVELOPMENT THERAPY EI PER 15 MIN OFF SITE","code_information":[{"code":"4400133","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96112","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96110 SP DEVELOPMENTAL & BEHAVIORAL SCREEN W/TEST","code_information":[{"code":"4400138","type":"CDM"},{"code":"0440","type":"RC"},{"code":"96110","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 97129 THERAPEUTIC INTERVENTION FOCUS CONGNITIVE FUNCTION 1ST 15 MINUTES","code_information":[{"code":"4400139","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 97130 THERAPEUTIC INTERVENTION FOCUS CONGNITIVE FUNCTION EA ADDL 15 MINUTES","code_information":[{"code":"4400140","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 97550 SP CAREGIVER TRAINING STRATEGIES&TQ 1ST 30 MIN","code_information":[{"code":"4400141","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 97551 SP CAREGIVER TRAINING STRATEGIES&TQ EA ADDL 15 MIN","code_information":[{"code":"4400142","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97551","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":42.0,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"},{"gross_charge":70.0,"discounted_cash":42.0,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 97552 SP GROUP CAREGIVER TRAINING STRATEGIES & TECHNIQUE","code_information":[{"code":"4400143","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97552","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"both","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"HC 10060 INC/DRN ABSCESS/CYST SIMPLE OR SINGLE","code_information":[{"code":"4500002","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10061 INC/DRN ABSCESS/CYST COMPLEX OR  MULTIPLE","code_information":[{"code":"4500003","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":2287.0,"discounted_cash":1372.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10080 INC/DRN PILONIDAL CYST SIMPLE","code_information":[{"code":"4500004","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":859.0,"discounted_cash":515.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10120 INC/REMOVE FB, SUBCUT, SIMPLE","code_information":[{"code":"4500005","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1357.0,"discounted_cash":814.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10121 INC/REMOVE FB, SUBCUT, COMPLEX","code_information":[{"code":"4500006","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":8708.0,"discounted_cash":5224.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10140 INC/DRN HEMATOMA, SEROMA, OR FLUID","code_information":[{"code":"4500007","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":4207.0,"discounted_cash":2524.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10160 PUNCTURE/ASP OF ABCESS, HEMATOMA, CYST","code_information":[{"code":"4500008","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.0,"discounted_cash":686.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10180 INC/DRN COMPLEX, POST OP WOUND INFECTION","code_information":[{"code":"4500009","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":3005.0,"discounted_cash":1803.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11010 DEBRIDE W/FB REM FX/DS SKIN/SQ TISSUE","code_information":[{"code":"4500011","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1128.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11011 DEBRIDE W/FB REM SKIN/SQ,MUSCLE","code_information":[{"code":"4500012","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11012 DEBRIDE W/FB REM SKIN/SQ,MUS/BONE","code_information":[{"code":"4500013","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3005.0,"discounted_cash":1803.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11042 DEBRIDE SKIN/SUB Q   PARTIAL THICKNESS","code_information":[{"code":"4500015","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":793.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11420 EXC, BENIGN LESION IN MARGIN <0.5CM","code_information":[{"code":"4500016","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":4956.0,"discounted_cash":2973.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11421 EXC BENIGN  LESION  0.6 TO 1.0 CM","code_information":[{"code":"4500017","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":5375.0,"discounted_cash":3225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11440 EXC BENIGN LESION <=0.5 CM","code_information":[{"code":"4500018","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1922.0,"discounted_cash":1153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11720 DEBRIDEMENT,NAIL, ANY METHOD  1-5","code_information":[{"code":"4500019","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.0,"discounted_cash":501.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11730 REMOVAL,NAIL PLATE,SIMPLE,SINGLE","code_information":[{"code":"4500020","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":279.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11732 REMOVAL NAIL PLATE, SIMPLE, EA ADD","code_information":[{"code":"4500021","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":261.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11740 EVACUATION OF SUBUNGUAL HEMATOMA","code_information":[{"code":"4500022","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11750 EXCIS NAIL/MATRIX,INGRN TOENAIL REM","code_information":[{"code":"4500023","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2116.0,"discounted_cash":1269.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11760 REPAIR OF NAIL BED","code_information":[{"code":"4500024","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":385.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11765 WEDGE EXCISION OF SKIN, NAIL FOLD","code_information":[{"code":"4500025","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12001 SIM REP,SLP,NCK,AXL,TRK,EXT<=2.5","code_information":[{"code":"4500026","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":385.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12002 SIM REP,SLP,NCK,AXL,TRK,EXT 2.6-7.5","code_information":[{"code":"4500027","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":396.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12004 SIM REP,SLP,NCK,AX,TRK,EXT7.6-12.5 CM","code_information":[{"code":"4500028","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":452.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12005 SIM REP,SLP,NCK,AX,TRK,EXT 12.6-20 CM","code_information":[{"code":"4500029","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"discounted_cash":485.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12006 SIM REP,SLP,NCK,AX,TRK,EXT 20.1-30 CM","code_information":[{"code":"4500030","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":576.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12007 SIM REP,SLP,NCK,AX,TRK,EXT >30 CM","code_information":[{"code":"4500031","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":592.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12011 SIM REP,FCE,EAR,EYE,NSE,LIP,MM<=2.5 CM","code_information":[{"code":"4500032","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":385.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12013 SIM REP,FCE,EAR,EYE,NSE,LIP,MM2.6-5 CM","code_information":[{"code":"4500033","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":666.0,"discounted_cash":399.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12014 SIM REP,FCE,EAR,EYE,NSE,LP,MM5.1-7.5 CM","code_information":[{"code":"4500034","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12015 SIM REP,FCE,EAR,EYE,NSE,LP,MM7.6-12.5 CM","code_information":[{"code":"4500035","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12016 SIM REP,FCE,EAR,EYE,NSE,LP,MM12.6-20 CM","code_information":[{"code":"4500036","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12017 SIM REP,FCE,EAR,EYE,NSE,LP,MM20.1-30 CM","code_information":[{"code":"4500037","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12018 SIM REPR FCE,EAR,EYE,NSE,LIP,MM>30 CM","code_information":[{"code":"4500038","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12018","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12031 LAYER CLOS,SCLP,SCL,TRK,EXT <=2.5 CM","code_information":[{"code":"4500039","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1353.0,"discounted_cash":811.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12032 LAYER CLOS,SCLP,AXL,TRK,EXT, 2.6-7.5 CM","code_information":[{"code":"4500040","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.0,"discounted_cash":847.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12034 LAYER CLOS,SCLP,AXL,TRK,EXT,7.6-12.5 CM","code_information":[{"code":"4500041","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12035 LAYER CLOS,SCLP,AXL,TRK,EXT,12.6-20 CM","code_information":[{"code":"4500042","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12036 LAYER CLOS,SCLP,AXL,TRK,EXT,20.1-30 CM","code_information":[{"code":"4500043","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12037 LAYER CLOS,SCLP,AXL,TRK,EXT,>30 CM","code_information":[{"code":"4500044","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12037","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12041 LAYER CLOS,NCK,HAND,FEET,GEN,<=2.5 CM","code_information":[{"code":"4500045","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12042 LAYER CLOS,NCK,HAND,FEET,GEN,2.6-7.5 CM","code_information":[{"code":"4500046","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12044 LAYER CLOS,NCK,HAND,FEET,GEN,7.6-12.5 CM","code_information":[{"code":"4500047","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12045 LAYER CLOS,NCK,HAND,FEET,GEN,12.6-20 CM","code_information":[{"code":"4500048","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12046 LAYER CLOS,NCK,HAND,FEET,GEN,20.1-30 CM","code_information":[{"code":"4500049","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12047 LAYER CLOS,NCK,HAND,FEET,GEN,>30 CM","code_information":[{"code":"4500050","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12047","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12051 LAYER CLOS,FCE,EAR,EYE,NSE,LP,MM<=2.5 CM","code_information":[{"code":"4500051","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12052 LAYER CLOS,FCE,EAR,EYE,NSE,LP,MM<=2.6-5 CM","code_information":[{"code":"4500052","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.0,"discounted_cash":583.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12053 LAYER CLOS,FCE,EAR,EYE,NSE,LP,MM,5.1-7.5 CM","code_information":[{"code":"4500053","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12054 LAYER CLOS,FCE,EAR,EYE,NSE,LP,MM,7.6-12.5 CM","code_information":[{"code":"4500054","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12055 LAYER CLOS,FCE,EAR,EYE,NSE,LP,MM,12.6-20 CM","code_information":[{"code":"4500055","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12056 LAYER CLOS,FCE,EAR,EYE,NSE,LP,MM,20.1-30 CM","code_information":[{"code":"4500056","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12056","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12057 LAYER CLOS,FCE,EAR,EYE,NSE,LIP,MM,>30 CM","code_information":[{"code":"4500057","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12057","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13100 REPAIR,COMPLEX,TRUNK,1.1-2.5 CM","code_information":[{"code":"4500058","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":739.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13101 REPAIR,COMPLEX,TRUNK,2.6-7.5 CM","code_information":[{"code":"4500059","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13102 REPAIR,COMPLEX,TRUNK,EA ADD 5 CM (OR <)","code_information":[{"code":"4500060","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13120 REPAIR,COMPLEX,SCLP,ARM,LEG,1.1-2.5 CM","code_information":[{"code":"4500061","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13121 REPAIR,COMPLEX,SCLP,ARM,LEG,2.6-7.5 CM","code_information":[{"code":"4500062","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13122 REPAIR,COMPLEX,SCLP,ARM,LG,EA ADD 5 CM(OR<)","code_information":[{"code":"4500063","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13131 RP,CPLX,FH,CHK,MO,NK,G,HN,FT1.1-2.5 CM","code_information":[{"code":"4500064","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13132 RP,CPLX,FH,CHK,MO,NK,G,HN,FT,2.6-7.5 CM","code_information":[{"code":"4500065","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13133 RP,CPLX,FH,CHK,MO,NK,G,HN,FT,ADD 5 CM (OR <)","code_information":[{"code":"4500066","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13151 REPAIR,CPLX,EYELID,NSE,EAR,LP 1.1-2.5 CM","code_information":[{"code":"4500068","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13152 REPAIR,CPLX,EYELID,NSE,EAR,LP 2.6-7.5-FAC","code_information":[{"code":"4500069","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13153 REPAIR,CPLX,EYELD,NSE,EAR,LP EA ADD 5 CM","code_information":[{"code":"4500070","type":"CDM"},{"code":"0450","type":"RC"},{"code":"13153","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":627.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14040 TISSUE TRNFR/REARN FCE/CHN/AX/HD/FT 10 SQCM (OR <)","code_information":[{"code":"4500071","type":"CDM"},{"code":"0450","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":10263.0,"discounted_cash":6157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14041 TISSUE TRNFR/REARN FCE/CHN/AX/HD/FT 10.1-30 SQCM","code_information":[{"code":"4500072","type":"CDM"},{"code":"0450","type":"RC"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":5783.0,"discounted_cash":3469.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14060 TISSUE TRANF/REARN EYE,NSE,EAR,LP 10 SQCM (OR< )","code_information":[{"code":"4500073","type":"CDM"},{"code":"0450","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":8198.0,"discounted_cash":4918.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15240 FULL THICK GRAFT FHD,CHN,NK,HD,FT 20 SQCM (OR<)","code_information":[{"code":"4500074","type":"CDM"},{"code":"0450","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":3581.0,"discounted_cash":2148.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 16000 INIT TX, LOCAL 1ST DEGREE BURN","code_information":[{"code":"4500075","type":"CDM"},{"code":"0450","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 16020 DRESS/DEBRID,BURN PART THICK SM <5% TBS","code_information":[{"code":"4500076","type":"CDM"},{"code":"0450","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 16025 DRESS/DEBRID,BURN PART THICK MED, 5-10% TBS","code_information":[{"code":"4500077","type":"CDM"},{"code":"0450","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":610.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 16030 DRESS/DEBRID,BURN PART THICK LG, >10% TBS","code_information":[{"code":"4500078","type":"CDM"},{"code":"0450","type":"RC"},{"code":"16030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":604.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 16035 ESCHAROTOMY, INITIAL INCISION","code_information":[{"code":"4500079","type":"CDM"},{"code":"0450","type":"RC"},{"code":"16035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":739.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 16036 ESCHAROTOMY, EA ADD INCISION","code_information":[{"code":"4500080","type":"CDM"},{"code":"0450","type":"RC"},{"code":"16036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 17110 DEST FLAT WART/MOLLUS/MILIA UP TO 14","code_information":[{"code":"4500081","type":"CDM"},{"code":"0450","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 17999 UNLISTED PROC SKIN,MUCOUS MEMBRANE/SQ","code_information":[{"code":"4500082","type":"CDM"},{"code":"0450","type":"RC"},{"code":"17999","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 19020 MASTOTOMY BREAST EXPL/DRN ABSCESS DEEP RT","code_information":[{"code":"4500083","type":"CDM"},{"code":"0450","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3172.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 19020 MASTOTOMY BREAST EXPL/DRN ABSCESS DEEP LT","code_information":[{"code":"4500084","type":"CDM"},{"code":"0450","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":5288.0,"discounted_cash":3172.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20101 EXPLORE PENETRATING WOUND CHEST","code_information":[{"code":"4500085","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20101","type":"HCPCS"}],"standard_charges":[{"gross_charge":7506.0,"discounted_cash":4503.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20102 EXPLORE PENETRATING WOUND ABD/FLNK/BACK","code_information":[{"code":"4500086","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20102","type":"HCPCS"}],"standard_charges":[{"gross_charge":8261.0,"discounted_cash":4956.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20103 EXPLORE PENETRATING WOUND EXTREMITY","code_information":[{"code":"4500087","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":3588.0,"discounted_cash":2152.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20220 BX BONE,TROCAR/NEEDLE SUPERFICIAL","code_information":[{"code":"4500088","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2582.0,"discounted_cash":1549.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20225 BX BONE,TROCAR/NEEDLE DEEP","code_information":[{"code":"4500089","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":7963.0,"discounted_cash":4777.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20520 REMOVAL FB MUSCLE/TENDON SIMPLE","code_information":[{"code":"4500090","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20552 INJECT, SGL/MULTI TRIGGER 1 OR 2 MUSCLE","code_information":[{"code":"4500093","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.0,"discounted_cash":628.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20650 INSERT WIRE/PIN SKELETAL TRACTION,INC REMOVAL","code_information":[{"code":"4500101","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20650","type":"HCPCS"}],"standard_charges":[{"gross_charge":8418.0,"discounted_cash":5050.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20660 APPL CRANIAL TONGS/CALIPER/FRAME,INC REMOVAL","code_information":[{"code":"4500102","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20660","type":"HCPCS"}],"standard_charges":[{"gross_charge":2265.0,"discounted_cash":1359.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20661 APPL HALO, CRANIAL, INC REMOVAL","code_information":[{"code":"4500103","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20661","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":989.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROC, MUSCULOSKELETAL,GEN","code_information":[{"code":"4500104","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20999","type":"HCPCS"}],"standard_charges":[{"gross_charge":6325.0,"discounted_cash":3795.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21315 CLSD TX NASAL BONE FX W/O STABILIZATION","code_information":[{"code":"4500106","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21315","type":"HCPCS"}],"standard_charges":[{"gross_charge":6440.0,"discounted_cash":3864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21480 CLSD TX,TMJ DISLOC,INIT/SUB RT","code_information":[{"code":"4500111","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":490.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 21480 CLSD TX,TMJ DISLOC,INIT/SUB LT","code_information":[{"code":"4500112","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.0,"discounted_cash":490.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 21480 CLSD TX,TMJ DISLOC,INIT/SUB BIL","code_information":[{"code":"4500113","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1283.0,"discounted_cash":769.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 21820 CLSD TX STERNUM FRACTURE","code_information":[{"code":"4500116","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21820","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22315 CLSD TX VTFX/DS CST/BR W W/O ANES MAN/TRC","code_information":[{"code":"4500119","type":"CDM"},{"code":"0450","type":"RC"},{"code":"22315","type":"HCPCS"}],"standard_charges":[{"gross_charge":3407.0,"discounted_cash":2044.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROC ABD, MUSCULOSKELETAL SYSTEM","code_information":[{"code":"4500120","type":"CDM"},{"code":"0450","type":"RC"},{"code":"22999","type":"HCPCS"}],"standard_charges":[{"gross_charge":6334.0,"discounted_cash":3800.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23330 REMOVAL  FB SHOULDER,SUBCUT RT","code_information":[{"code":"4500121","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2850.0,"discounted_cash":1710.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23330 REMOVAL  FB SHOULDER,SUBCUT LT","code_information":[{"code":"4500122","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2850.0,"discounted_cash":1710.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23500 CLSD TX, CLAVICAL FX W/O MANIP RT","code_information":[{"code":"4500123","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23500 CLSD TX, CLAVICAL FX W/O MANIP LT","code_information":[{"code":"4500124","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23570 CLSD SCAPULAR FRACT W/O MANIP RT","code_information":[{"code":"4500125","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23570 CLSD SCAPULAR FRACT W/O MANIP LT","code_information":[{"code":"4500126","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23605 CLSD TX PROX HUMERAL FX W/MAN RT","code_information":[{"code":"4500127","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":4121.0,"discounted_cash":2472.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23605 CLSD TX PROX HUMERAL FX W/MAN LT","code_information":[{"code":"4500128","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":4436.0,"discounted_cash":2661.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23620 CLSD TX,GREATR HUM TUB FX W/O MANIP RT","code_information":[{"code":"4500129","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23620 CLSD TX,GREATR HUM TUB FX W/O MANIP LT","code_information":[{"code":"4500130","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23620 CLSD TX,GREATR HUM TUB FX W/O MANIP BIL","code_information":[{"code":"4500131","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.0,"discounted_cash":514.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 23650 CLSD TX,SHLD DISL, W/MAN W/O ANES RT","code_information":[{"code":"4500132","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":918.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23650 CLSD TX,SHLD DISL, W/MAN W/O ANES LT","code_information":[{"code":"4500133","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1531.0,"discounted_cash":918.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23650 CLSD TX,SHLD DISL, W/MAN W/O ANES BIL","code_information":[{"code":"4500134","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2297.0,"discounted_cash":1378.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 23665 CLSD TX,SHL DSL,W/FX GRTUBR,W/MAN RT","code_information":[{"code":"4500135","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2206.0,"discounted_cash":1323.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23665 CLSD TX,SHL DSL,W/FX GRTUBR,W/MAN LT","code_information":[{"code":"4500136","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2375.0,"discounted_cash":1425.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23931 INC/DRN, UPPER ARM/ELBOW, BURSA RT","code_information":[{"code":"4500137","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":3698.0,"discounted_cash":2218.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23931 INC/DRN, UPPER ARM/ELBOW, BURSA LT","code_information":[{"code":"4500138","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":3698.0,"discounted_cash":2218.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24500 CLSD TX,HUM SHFT FX W/O MANIP RT","code_information":[{"code":"4500141","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":610.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24500 CLSD TX,HUM SHFT FX W/O MANIP LT","code_information":[{"code":"4500142","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":610.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24505 CLSD TX,HUM SHFT FX WITH MANIP RT","code_information":[{"code":"4500143","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24505 CLSD TX,HUM SHFT FX WITH MANIP LT","code_information":[{"code":"4500144","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24530 CLSD TX,SUP/TRAN HUM FX,W/0 MANIP RT","code_information":[{"code":"4500145","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":415.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24530 CLSD TX,SUP/TRAN HUM FX,W/0 MANIP LT","code_information":[{"code":"4500146","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.0,"discounted_cash":415.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24535 CLSD TX,SUP/TRAN HUM FX, WITH MANIP RT","code_information":[{"code":"4500147","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2705.0,"discounted_cash":1623.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24535 CLSD TX,SUP/TRAN HUM FX, WITH MANIP LT","code_information":[{"code":"4500148","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2912.0,"discounted_cash":1747.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24560 CLSD HUM EPICONDYLAR FX W/O MANIP RT","code_information":[{"code":"4500149","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24560 CLSD HUM EPICONDYLAR FX W/O MANIP LT","code_information":[{"code":"4500150","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24565 CLSD HUM EPICONDYLAR FX WITH MANIP RT","code_information":[{"code":"4500151","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24565 CLSD HUM EPICONDYLAR FX WITH MANIP LT","code_information":[{"code":"4500152","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24600 CLSD TX, ELBOW DISLOC, W/O ANES RT","code_information":[{"code":"4500153","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":558.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24600 CLSD TX, ELBOW DISLOC, W/O ANES LT","code_information":[{"code":"4500154","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":558.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24640 CLSD TX, RAD HD SUBLUX CHILD WITH MANIP RT","code_information":[{"code":"4500155","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":558.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24640 CLSD TX, RAD HD SUBLUX CHILD WITH MANIP LT","code_information":[{"code":"4500156","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":931.0,"discounted_cash":558.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24650 CLSD TX, RAD HEAD/NECK FX, W/O MANIP RT","code_information":[{"code":"4500157","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24650 CLSD TX, RAD HEAD/NECK FX, W/O MANIP LT","code_information":[{"code":"4500158","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24655 CLSD TX, RAD HEAD/NECK FX, WITH MANIP RT","code_information":[{"code":"4500159","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":2485.0,"discounted_cash":1491.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24655 CLSD TX, RAD HEAD/NECK FX, WITH MANIP LT","code_information":[{"code":"4500160","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24675 CLSD TX, ULNAR FX, PROX END WITH MANIP RT","code_information":[{"code":"4500163","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24675 CLSD TX, ULNAR FX, PROX END WITH MANIP LT","code_information":[{"code":"4500164","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25260 REP TEND/MUSC FOREARM/WRIST PRIM SGL EA","code_information":[{"code":"4500165","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":12522.0,"discounted_cash":7513.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25263 REP TEND/MUSC FOREARM/WRIST SECON SGL EA","code_information":[{"code":"4500166","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25263","type":"HCPCS"}],"standard_charges":[{"gross_charge":11378.0,"discounted_cash":6826.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25500 CLSD TX, RADIAL SHAFT FX, W/O MANIP RT","code_information":[{"code":"4500167","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25500 CLSD TX, RADIAL SHAFT FX, W/O MANIP LT","code_information":[{"code":"4500168","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25505 CLSD TX, RADIAL SHAFT FX WITH MANIP RT","code_information":[{"code":"4500169","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2215.0,"discounted_cash":1329.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25505 CLSD TX, RADIAL SHAFT FX WITH MANIP LT","code_information":[{"code":"4500170","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2383.0,"discounted_cash":1429.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25520 CLSD TX RAD SHFT FX/DIS RADIOULNAR JT RT","code_information":[{"code":"4500171","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25520 CLSD TX RAD SHFT FX/DIS RADIOULNAR JT LT","code_information":[{"code":"4500172","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25530 CLSD TX, ULNAR SHAFT FX, W/O MANIP RT","code_information":[{"code":"4500173","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25530 CLSD TX, ULNAR SHAFT FX, W/O MANIP LT","code_information":[{"code":"4500174","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25560 CLSD TX RAD & ULNAR FX W/O MANIP RT","code_information":[{"code":"4500175","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25560 CLSD TX RAD & ULNAR FX W/O MANIP LT","code_information":[{"code":"4500176","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25565 CLSD TX RAD & ULNAR FX WITH MANIP RT","code_information":[{"code":"4500177","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1066.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25565 CLSD TX RAD & ULNAR FX WITH MANIP LT","code_information":[{"code":"4500178","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1066.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25600 CLSD,DIST RAD FX/EPIPHY,W/O MANIP RT","code_information":[{"code":"4500179","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25600 CLSD,DIST RAD FX/EPIPHY,W/O MANIP LT","code_information":[{"code":"4500180","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25605 CLSD,DIST RAD FX/EPIPHY,WITH MANIP RT","code_information":[{"code":"4500181","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2391.0,"discounted_cash":1434.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25605 CLSD,DIST RAD FX/EPIPHY,WITH MANIP LT","code_information":[{"code":"4500182","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2391.0,"discounted_cash":1434.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25622 CLSD TX CARPAL SCAPH(NAVICULAR) FX W/O MANIP RT","code_information":[{"code":"4500183","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25622 CLSD TX CARPAL SCAPH(NAVICULAR) FX W/O MANIP LT","code_information":[{"code":"4500184","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25624 CLSD TX CARPAL SCAPH(NAVICULAR) FX WITH MANIP RT","code_information":[{"code":"4500185","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"discounted_cash":1038.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25624 CLSD TX CARPAL SCAPH(NAVICULAR) FX WITH MANIP LT","code_information":[{"code":"4500186","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"discounted_cash":1038.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25630 CLSD CARP FX (NO NAV) W/O MANIP,EA RT","code_information":[{"code":"4500187","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25630 CLSD CARP FX (NO NAV) W/O MANIP,EA LT","code_information":[{"code":"4500188","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25650 CLSD TX ULNAR STYLOID FX RT","code_information":[{"code":"4500189","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25650 CLSD TX ULNAR STYLOID FX LT","code_information":[{"code":"4500190","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26010 DRAINAGE OF FINGER ABCESS, SINGLE","code_information":[{"code":"4500191","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":451.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26011 DRAINAGE OF FINGER ABCESS, COMPLICATED","code_information":[{"code":"4500192","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":4762.0,"discounted_cash":2857.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26350 REP/ADV FEXOR TEND NT ZNE 2 EA TENDON RT","code_information":[{"code":"4500193","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":7649.0,"discounted_cash":4589.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26350 REP/ADV FEXOR TEND NT ZNE 2 EA TENDON LT","code_information":[{"code":"4500194","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":7649.0,"discounted_cash":4589.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26418 REPR,EXTEN TENDON,FING W/O FR GRAFT, EA","code_information":[{"code":"4500195","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":5436.0,"discounted_cash":3261.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26432 CLSD TX DIST TENDON WITH OR W/O PINNING","code_information":[{"code":"4500196","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26432","type":"HCPCS"}],"standard_charges":[{"gross_charge":7048.0,"discounted_cash":4228.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26433 REPAIR EXTENSOR TENDON W/O GRAFT","code_information":[{"code":"4500197","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26433","type":"HCPCS"}],"standard_charges":[{"gross_charge":6111.0,"discounted_cash":3666.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26600 CLSD METACARPAL FX W/O MANIP EA BONE RT","code_information":[{"code":"4500198","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26600 CLSD METACARPAL FX W/O MANIP EA BONE LT","code_information":[{"code":"4500199","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26605 CLSD METACARPAL FX WITH MANIP EA BONE RT","code_information":[{"code":"4500200","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":745.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26605 CLSD METACARPAL FX WITH MANIP EA BONE LT","code_information":[{"code":"4500201","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":745.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26641 CLSD CARPOMETA DISL,THUMB,WITH MANIP RT","code_information":[{"code":"4500202","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26641 CLSD CARPOMETA DISL,THUMB,WITH MANIP LT","code_information":[{"code":"4500203","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":546.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26645 CLSD TX (BENNETT FX) WITH MANIP  RT","code_information":[{"code":"4500204","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26645 CLSD TX (BENNETT FX) WITH MANIP  LT","code_information":[{"code":"4500205","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26670 CLSD CARPMETA DISL(NO THUMB)WITH MANIP RT","code_information":[{"code":"4500206","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26670 CLSD CARPMETA DISL(NO THUMB)WITH MANIP LT","code_information":[{"code":"4500207","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26700 CLSD METACARP DISL,SNGL,WITH MANIP","code_information":[{"code":"4500208","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":500.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26720 CLSD SHAFT FX,PRX/MID FNG W/O MANIP","code_information":[{"code":"4500209","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26725 CLSD SHAFT FX PRX/MID FNG/THUM WITH MANIP","code_information":[{"code":"4500210","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":739.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26740 CLSD TX ARTICULAR FX W/O MANIP EACH","code_information":[{"code":"4500211","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26740","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26742 CLSD TX ARTICULAR FX WITH MANIP EACH","code_information":[{"code":"4500212","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26750 CLSD DISTAL PHALANG FX, W/O MANIP, EA","code_information":[{"code":"4500213","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26755 CLSD DISTAL PHALANG FX, WITH MANIP, EA","code_information":[{"code":"4500214","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26765 OPEN TX, DIST PHAL FX, FING/THMB, EA","code_information":[{"code":"4500215","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":16713.0,"discounted_cash":10027.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26770 CLSD TX INTRPH JOINT DISL, SNG WITH MANIP","code_information":[{"code":"4500216","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":500.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26775 CLSD INTRPH JT DIS, SNG MANIP WITH ANES","code_information":[{"code":"4500217","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26775","type":"HCPCS"}],"standard_charges":[{"gross_charge":4359.0,"discounted_cash":2615.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26785 OPEN PHALANX FX WITH OR W/O MANIP","code_information":[{"code":"4500218","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26785","type":"HCPCS"}],"standard_charges":[{"gross_charge":6734.0,"discounted_cash":4040.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26951 AMP FGR OR THMB;ANY JOINT SGL WITH CLOSURE","code_information":[{"code":"4500219","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":4933.0,"discounted_cash":2959.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26952 AMPUTATE-FINGER/THUMB WITH FLAP","code_information":[{"code":"4500220","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":5496.0,"discounted_cash":3297.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE,HANDS OR FINGERS","code_information":[{"code":"4500221","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26989","type":"HCPCS"}],"standard_charges":[{"gross_charge":1229.0,"discounted_cash":737.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27220 CLSD ACETABULUM FRACTURE, W/O MANIP RT","code_information":[{"code":"4500226","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":308.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27220 CLSD ACETABULUM FRACTURE, W/O MANIP LT","code_information":[{"code":"4500227","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":308.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27238 CLSD TROCHAN FEMORAL FX,W/O MANIP RT","code_information":[{"code":"4500228","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3538.0,"discounted_cash":2122.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27238 CLSD TROCHAN FEMORAL FX,W/O MANIP LT","code_information":[{"code":"4500229","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3538.0,"discounted_cash":2122.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27250 CLSD HIP DISLOC, TRAUMA, W/O ANES RT","code_information":[{"code":"4500230","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27250 CLSD HIP DISLOC, TRAUMA, W/O ANES LT","code_information":[{"code":"4500231","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27265 CLSD POST HIP ARTHR DISL,W/O ANES RT","code_information":[{"code":"4500234","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":316.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27265 CLSD POST HIP ARTHR DISL,W/O ANES LT","code_information":[{"code":"4500235","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":316.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27266 CLSD TX POST HIP ARTH DIS WITH ANES RT","code_information":[{"code":"4500236","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":2762.0,"discounted_cash":1657.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27266 CLSD TX POST HIP ARTH DIS WITH ANES LT","code_information":[{"code":"4500237","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":2566.0,"discounted_cash":1539.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27301 INC/DRN  DEEP ABCESS BURSA/HEMATOMA","code_information":[{"code":"4500238","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":6463.0,"discounted_cash":3877.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27502 CLSD TX,FEMORAL SHAFT FX,WITH MANIP RT","code_information":[{"code":"4500239","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":4319.0,"discounted_cash":2591.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27502 CLSD TX,FEMORAL SHAFT FX,WITH MANIP LT","code_information":[{"code":"4500240","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":4649.0,"discounted_cash":2789.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27508 CLSD FEMOR FX, DIST, CONDY W/O MANIP RT","code_information":[{"code":"4500243","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27508 CLSD FEMOR FX, DIST, CONDY W/O MANIP LT","code_information":[{"code":"4500244","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27510 CLSD FEMOR FX, DIST, CONDY WITH MANIP RT","code_information":[{"code":"4500245","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27510 CLSD FEMOR FX, DIST, CONDY WITH MANIP LT","code_information":[{"code":"4500246","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27520 CLSD PATELLAR FRACTURE,W/O MANIP RT","code_information":[{"code":"4500249","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":745.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27520 CLSD PATELLAR FRACTURE,W/O MANIP LT","code_information":[{"code":"4500250","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1243.0,"discounted_cash":745.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27560 CLSD PATELLAR DISLOC, W/O ANES RT","code_information":[{"code":"4500251","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27560 CLSD PATELLAR DISLOC, W/O ANES LT","code_information":[{"code":"4500252","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27750 CLSD TX TIBIAL SHAFT FX,W/O MANIP RT","code_information":[{"code":"4500253","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":316.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27750 CLSD TX TIBIAL SHAFT FX,W/O MANIP LT","code_information":[{"code":"4500254","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":316.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27752 CLSD TX TIBIAL SHAFT FX WITH MANIP RT","code_information":[{"code":"4500255","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":3049.0,"discounted_cash":1829.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27752 CLSD TX TIBIAL SHAFT FX WITH MANIP LT","code_information":[{"code":"4500256","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":3049.0,"discounted_cash":1829.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27760 CLSD MEDIAL MALLEOUS FX,W/O MANIP RT","code_information":[{"code":"4500257","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27760 CLSD MEDIAL MALLEOUS FX,W/O MANIP LT","code_information":[{"code":"4500258","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27762 CLSD MEDIAL MALLEOUS FX,WITH  MANIP RT","code_information":[{"code":"4500259","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3144.0,"discounted_cash":1886.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27762 CLSD MEDIAL MALLEOUS FX,WITH  MANIP LT","code_information":[{"code":"4500260","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":3144.0,"discounted_cash":1886.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27780 CLSD PROX FIBULA/SHFT FX,W/O MANIP RT","code_information":[{"code":"4500261","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":663.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27780 CLSD PROX FIBULA/SHFT FX,W/O MANIP LT","code_information":[{"code":"4500262","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1106.0,"discounted_cash":663.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27781 CLSD FIBULA FX WITH MANIP RT","code_information":[{"code":"4500263","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6977.0,"discounted_cash":4186.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27781 CLSD FIBULA FX WITH MANIP LT","code_information":[{"code":"4500264","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6977.0,"discounted_cash":4186.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27786 CLSD DISTAL FIBULA FX W/O MANIP RT","code_information":[{"code":"4500265","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27786 CLSD DISTAL FIBULA FX W/O MANIP LT","code_information":[{"code":"4500266","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27788 CLSD DISTAL FIBULA FX WITH MANIP RT","code_information":[{"code":"4500267","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":537.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27788 CLSD DISTAL FIBULA FX WITH MANIP LT","code_information":[{"code":"4500268","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":537.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27808 CLSD BIMALLEOLAR ANKLE FX,W/O MANIP RT","code_information":[{"code":"4500269","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27808 CLSD BIMALLEOLAR ANKLE FX,W/O MANIP LT","code_information":[{"code":"4500270","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27810 CLSD BIMALLEOLAR ANKLE FX,WITH MANIP RT","code_information":[{"code":"4500271","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27810 CLSD BIMALLEOLAR ANKLE FX,WITH MANIP LT","code_information":[{"code":"4500272","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27816 CLSD TRIMALLIOLA ANKLE FX,W/O MANIP RT","code_information":[{"code":"4500273","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27816 CLSD TRIMALLIOLA ANKLE FX,W/O MANIP LT","code_information":[{"code":"4500274","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27818 CLSD TRIMALLIOLA ANKLE FX,WITH MANIP RT","code_information":[{"code":"4500275","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27818 CLSD TRIMALLIOLA ANKLE FX,WITH MANIP LT","code_information":[{"code":"4500276","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27824 CLSD TX TIBIA FX W/O MANIP RT","code_information":[{"code":"4500277","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":355.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27824 CLSD TX TIBIA FX W/O MANIP LT","code_information":[{"code":"4500278","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":355.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27830 CLSD TX PROX TIBIOFIBULAR JT DIS RT","code_information":[{"code":"4500279","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27830 CLSD TX PROX TIBIOFIBULAR JT DIS LT","code_information":[{"code":"4500280","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27840 CLSD ANKLE DISLOCATION, W/O ANES RT","code_information":[{"code":"4500281","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27840 CLSD ANKLE DISLOCATION, W/O ANES LT","code_information":[{"code":"4500282","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28190 REMOVE FB FOOT, SUBCUT RT","code_information":[{"code":"4500283","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":3128.0,"discounted_cash":1876.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28190 REMOVE FB FOOT, SUBCUT LT","code_information":[{"code":"4500284","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":3128.0,"discounted_cash":1876.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28192 REMOVE FB FOOT, DEEP RT","code_information":[{"code":"4500285","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":6759.0,"discounted_cash":4055.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28192 REMOVE FB FOOT, DEEP LT","code_information":[{"code":"4500286","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":6759.0,"discounted_cash":4055.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28400 CLSD CALCANEAL FRACT,W/O MANIP RT","code_information":[{"code":"4500287","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28400 CLSD CALCANEAL FRACT,W/O MANIP LT","code_information":[{"code":"4500288","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28430 CLSD TALUS FRACT,W/O MANIP RT","code_information":[{"code":"4500289","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":568.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28430 CLSD TALUS FRACT,W/O MANIP LT","code_information":[{"code":"4500290","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":568.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28435 CLSD TALUS FRACT,WITH MANIP RT","code_information":[{"code":"4500291","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":3631.0,"discounted_cash":2178.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28435 CLSD TALUS FRACT,WITH MANIP LT","code_information":[{"code":"4500292","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":3631.0,"discounted_cash":2178.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28470 CLSD METATARSAL FRAC, W/O MANIP , EA","code_information":[{"code":"4500293","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28475 CLSD METATARSAL FX WITH MANIP, EA","code_information":[{"code":"4500294","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.0,"discounted_cash":708.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28490 CLSD FX GRT TOE/PHALAN/, W/O MANIP RT","code_information":[{"code":"4500295","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28490 CLSD FX GRT TOE/PHALAN/, W/O MANIP LT","code_information":[{"code":"4500296","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28495 CLSD FX GRT TOE/PHALAN/, WITH MANIP RT","code_information":[{"code":"4500297","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":389.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28495 CLSD FX GRT TOE/PHALAN/, WITH MANIP LT","code_information":[{"code":"4500298","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":389.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28505 OPEN FX GREAT TOE WITH OR W/O MANIP","code_information":[{"code":"4500299","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28505","type":"HCPCS"}],"standard_charges":[{"gross_charge":8418.0,"discounted_cash":5050.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28510 CLSD FX PHAL/(NOT GRT) W/O MANIP, EA","code_information":[{"code":"4500300","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":337.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28515 CLSD FX PHAL/(NOT GRT) WITH MANIP, EA","code_information":[{"code":"4500301","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1017.0,"discounted_cash":610.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28630 CLSD METATARSOPHAL DISL, W/O ANES","code_information":[{"code":"4500304","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":500.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28660 CLSD TX, INTERPHAL DISLOC, W/O ANES","code_information":[{"code":"4500305","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28660","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":500.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29065 APPLICATION CAST SHOULDER TO HAND RT","code_information":[{"code":"4500306","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29065 APPLICATION CAST SHOULDER TO HAND LT","code_information":[{"code":"4500307","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29075 APPLICATION CAST ELBOW TO FINGER RT","code_information":[{"code":"4500308","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29075 APPLICATION CAST ELBOW TO FINGER LT","code_information":[{"code":"4500309","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29085 APPLICATION, CAST HAND/FORARM (GUANTLET) RT","code_information":[{"code":"4500310","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":333.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29085 APPLICATION, CAST HAND/FORARM (GUANTLET) LT","code_information":[{"code":"4500311","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":333.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29105 APPLICATION ,LONG ARM SPLINT RT","code_information":[{"code":"4500312","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29105 APPLICATION ,LONG ARM SPLINT LT","code_information":[{"code":"4500313","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 APPLICATION , SHORT ARM SPLINT, STATIC RT","code_information":[{"code":"4500314","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 APPLICATION , SHORT ARM SPLINT, STATIC LT","code_information":[{"code":"4500315","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 APPLICATION, SHORT ARM SPLINT, STATIC BIL","code_information":[{"code":"4500316","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29130 APPLICATION FINGER SPLINT, STATIC","code_information":[{"code":"4500317","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":238.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29131 APPLICATION OF FINGER SPLINT DYNAMIC","code_information":[{"code":"4500318","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29240 STRAPPING, SHOULDER RT","code_information":[{"code":"4500319","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29240 STRAPPING, SHOULDER LT","code_information":[{"code":"4500320","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29260 STRAPPING, ELBOW OR WRIST RT","code_information":[{"code":"4500321","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29260 STRAPPING, ELBOW OR WRIST LT","code_information":[{"code":"4500322","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29280 STRAPPING, HAND OR FINGER RT","code_information":[{"code":"4500323","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29280 STRAPPING, HAND OR FINGER LT","code_information":[{"code":"4500324","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29345 APPLICATION  LONG LEG CAST (THIGH TO TOES) RT","code_information":[{"code":"4500325","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29345 APPLICATION  LONG LEG CAST (THIGH TO TOES) LT","code_information":[{"code":"4500326","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29405 APPLICATION SHORT LEG CAST (BELOW KNEE) RT","code_information":[{"code":"4500327","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29405 APPLICATION SHORT LEG CAST (BELOW KNEE) LT","code_information":[{"code":"4500328","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29425 APPLICATION SHORT LEG CAST WALKING TYPE RT","code_information":[{"code":"4500329","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29425 APPLICATION SHORT LEG CAST WALKING TYPE LT","code_information":[{"code":"4500330","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29505 APPLICATION , LONG LEG SPLINT RT","code_information":[{"code":"4500331","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29505 APPLICATION , LONG LEG SPLINT LT","code_information":[{"code":"4500332","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29515 APPLICATION SHORT LEG SPLINT (CALF/FOOT) RT","code_information":[{"code":"4500333","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29515 APPLICATION SHORT LEG SPLINT (CALF/FOOT) LT","code_information":[{"code":"4500334","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":289.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29515 APPLICATION SHORT LEG SPLINT (CALF/FOOT) BIL","code_information":[{"code":"4500335","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29530 STRAPPING, KNEE RT","code_information":[{"code":"4500336","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29530 STRAPPING, KNEE LT","code_information":[{"code":"4500337","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29540 STRAPPING, ANKLE RT","code_information":[{"code":"4500338","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":263.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29540 STRAPPING, ANKLE LT","code_information":[{"code":"4500339","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":263.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29700 REM/BIVAL,GAUNTLET,BOOT,BDY CAST RT","code_information":[{"code":"4500340","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29700 REM/BIVAL,GAUNTLET,BOOT,BDY CAST LT","code_information":[{"code":"4500341","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29705 REMOVE/BIVALVE, FULL ARM/LEG CAST RT","code_information":[{"code":"4500342","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":333.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29705 REMOVE/BIVALVE, FULL ARM/LEG CAST LT","code_information":[{"code":"4500343","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.0,"discounted_cash":333.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29705 REMOVE/BIVALVE, FULL ARM/LEG CAST BIL","code_information":[{"code":"4500344","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":832.0,"discounted_cash":499.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC UNLISTED PROCEDURE, CASTING OR STRAPPING","code_information":[{"code":"4500345","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":709.0,"discounted_cash":425.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 30300 REMOVAL FB, INTRANASAL","code_information":[{"code":"4500346","type":"CDM"},{"code":"0450","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 30901 CONTRL NASAL HEMORRHAGE,ANTER,SIMPLE","code_information":[{"code":"4500347","type":"CDM"},{"code":"0450","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":356.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 30903 CONTR NASAL HEMORRHAG,ANTER,COMPLEX","code_information":[{"code":"4500348","type":"CDM"},{"code":"0450","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.0,"discounted_cash":570.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 30905 CONTR NASAL HEMORRHAG,POST,INITIAL","code_information":[{"code":"4500349","type":"CDM"},{"code":"0450","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":854.0,"discounted_cash":512.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 30906 CONTR NASAL HEMORRHAG,POST,SUBSEQ","code_information":[{"code":"4500350","type":"CDM"},{"code":"0450","type":"RC"},{"code":"30906","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE NOSE","code_information":[{"code":"4500351","type":"CDM"},{"code":"0450","type":"RC"},{"code":"30999","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31231 NASAL ENDO,DIAG,UNI OR BLT","code_information":[{"code":"4500352","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31231","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31500 INTUBATION,ENDOTRACHEAL, EMER PROCEDURE","code_information":[{"code":"4500353","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1175.0,"discounted_cash":705.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31502 TRACH TUBE CHANGE,PRIOR TO EST FISTULA TRACT","code_information":[{"code":"4500354","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31502","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31505 LARYNGOSCOPY, INDIRECT, DIAGNOSTIC","code_information":[{"code":"4500355","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31505","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31511 LARYNGOSCOPY, INDIRECT, WITH REMOVAL FB","code_information":[{"code":"4500356","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31511","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31525 LARYNGOSCOPY DIRECT DIAGNOSTIC","code_information":[{"code":"4500357","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31525","type":"HCPCS"}],"standard_charges":[{"gross_charge":3477.0,"discounted_cash":2086.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31575 LARYNGOSCOPY, FLEXIBLE, DIAGNOSTIC","code_information":[{"code":"4500358","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":580.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31603 TRACHEOSTOMY, EMERG PROC, TRANSTRACHEAL","code_information":[{"code":"4500360","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.0,"discounted_cash":933.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31605 TRACHEOSTOMY, CRICOTHYROID MEMBRANE","code_information":[{"code":"4500361","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.0,"discounted_cash":1128.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31615 TRACHEOBRONCHOSCOPY THRU TRACH INCISION","code_information":[{"code":"4500362","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1701.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31622 BRONCH PROC RIDIG/FLEX W/W/O FLUROSCOPY","code_information":[{"code":"4500363","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31622","type":"HCPCS"}],"standard_charges":[{"gross_charge":3451.0,"discounted_cash":2070.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31635 BRONCHOSCOPY WW/O FLURO WITH REMOVAL FB","code_information":[{"code":"4500364","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32160 THORACOTOMY, W/CARDIAC MASSAGE","code_information":[{"code":"4500365","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32160","type":"HCPCS"}],"standard_charges":[{"gross_charge":1609.0,"discounted_cash":965.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32551 INSERTION OF CHEST TUBE RT","code_information":[{"code":"4500370","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"discounted_cash":1038.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32551 INSERTION OF CHEST TUBE LT","code_information":[{"code":"4500371","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"discounted_cash":1038.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32551 INSERTION OF CHEST TUBE BIL","code_information":[{"code":"4500372","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1862.0,"discounted_cash":1117.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC UNLISTED PROCEDURE LUNG/PLEURA","code_information":[{"code":"4500373","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":560.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33210 INS/RPL TMP SNGL CHMB ELEC/PMKR CATH","code_information":[{"code":"4500375","type":"CDM"},{"code":"0450","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":12649.0,"discounted_cash":7589.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 35206 REPAIR BLOOD VESSEL,DIRECT UPPER EXT","code_information":[{"code":"4500376","type":"CDM"},{"code":"0450","type":"RC"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":7533.0,"discounted_cash":4519.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 35226 REPAIR BLOOD VESSEL,DIRECT LOWER EXT","code_information":[{"code":"4500377","type":"CDM"},{"code":"0450","type":"RC"},{"code":"35226","type":"HCPCS"}],"standard_charges":[{"gross_charge":4281.0,"discounted_cash":2568.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36011 SEL CATH PLC VENOUS 1ST ORDER RT","code_information":[{"code":"4500378","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2907.0,"discounted_cash":1744.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36011 SEL CATH PLC VENOUS 1ST ORDER LT","code_information":[{"code":"4500379","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2907.0,"discounted_cash":1744.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC VENIPUNCTURE <3 YRS FEM/JUGULAR","code_information":[{"code":"4500381","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36400","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36410 VENIPUNCTURE, AGE 3 OR >, FOR DX/TX PURPOSES (NOT ROUTINE VENIPUNCTURE)","code_information":[{"code":"4500382","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36410","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":114.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36555 INSERT NON TUNNELED CI CVC <5YRS","code_information":[{"code":"4500385","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3727.0,"discounted_cash":2236.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36556 INSERT NON-TUNNELED CI CVC > 5YRS","code_information":[{"code":"4500386","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":4290.0,"discounted_cash":2574.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36560 INSERT TUNNELED CI CVP <5 YRS","code_information":[{"code":"4500387","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36560","type":"HCPCS"}],"standard_charges":[{"gross_charge":9353.0,"discounted_cash":5611.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36561 INSERT TUNNELED CI CVP >5 YRS","code_information":[{"code":"4500388","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":10997.0,"discounted_cash":6598.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36568 PICC LINE INSERTION  W/O SUBQ PORT < 5YRS W/O IMAGING GUIDE","code_information":[{"code":"4500389","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36568","type":"HCPCS"}],"standard_charges":[{"gross_charge":8487.0,"discounted_cash":5092.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36569 PICC LINE INSERTION W/O SUBQ PORT >5YRS W/O IMAGING GUIDE","code_information":[{"code":"4500390","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":4883.0,"discounted_cash":2929.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36600 ARTERIAL PUNCTURE, COLLECT FOR DIAG","code_information":[{"code":"4500391","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36620 ARTERIAL CATH SAMPLING/TRNSFSN,PERC","code_information":[{"code":"4500392","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":288.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36680 PLACE NEEDLE FOR INTRAOSSEOUS INFUSION","code_information":[{"code":"4500393","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":415.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37195 THROMBLYSIS CEREBRAL BYVENOUS INFUSION","code_information":[{"code":"4500394","type":"CDM"},{"code":"0450","type":"RC"},{"code":"37195","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":821.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37609 LIGATION OR BIOPSY, TEMPORAL ARTERY","code_information":[{"code":"4500396","type":"CDM"},{"code":"0450","type":"RC"},{"code":"37609","type":"HCPCS"}],"standard_charges":[{"gross_charge":6582.0,"discounted_cash":3949.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE,VASCULAR SURGERY","code_information":[{"code":"4500397","type":"CDM"},{"code":"0450","type":"RC"},{"code":"37799","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.0,"discounted_cash":439.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38221 DIAGNOSTIC BONE MARROW; BIOPSY","code_information":[{"code":"4500398","type":"CDM"},{"code":"0450","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 40650 REPAIR LP,FULL THICK,VERMILION ONLY","code_information":[{"code":"4500399","type":"CDM"},{"code":"0450","type":"RC"},{"code":"40650","type":"HCPCS"}],"standard_charges":[{"gross_charge":3659.0,"discounted_cash":2195.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 40652 REPAIR LP,FULL THICK UP TO 1/2 VERTICAL","code_information":[{"code":"4500400","type":"CDM"},{"code":"0450","type":"RC"},{"code":"40652","type":"HCPCS"}],"standard_charges":[{"gross_charge":3325.0,"discounted_cash":1995.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 40800 DRN ABCESS,CYST,HEMATOMA MOUTH SIMPLE","code_information":[{"code":"4500401","type":"CDM"},{"code":"0450","type":"RC"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":443.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 40830 REPAIR LAC, VESTIBULE OF MOUTH, 2.5CM(OR<)","code_information":[{"code":"4500402","type":"CDM"},{"code":"0450","type":"RC"},{"code":"40830","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 40831 REPAIR LAC, VESTIBULE OF MOUTH, >2.5CM","code_information":[{"code":"4500403","type":"CDM"},{"code":"0450","type":"RC"},{"code":"40831","type":"HCPCS"}],"standard_charges":[{"gross_charge":2280.0,"discounted_cash":1368.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41008 INTRAORAL INCISION ABSCESS SUBMANDIBULA","code_information":[{"code":"4500404","type":"CDM"},{"code":"0450","type":"RC"},{"code":"41008","type":"HCPCS"}],"standard_charges":[{"gross_charge":7750.0,"discounted_cash":4650.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41250 REPAIR LAC 2.5 OR <,FLR MTH/ANT TONG","code_information":[{"code":"4500405","type":"CDM"},{"code":"0450","type":"RC"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":347.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41252 REPAIR LAC TONGUE, >2.6CM OR COMPLEX","code_information":[{"code":"4500406","type":"CDM"},{"code":"0450","type":"RC"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":723.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41800 DRAIN ABSCESS,CYST,HEMAT DENTOALVE","code_information":[{"code":"4500407","type":"CDM"},{"code":"0450","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":451.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41899 DENTOLALVEOLAR PROC,UNLISTED","code_information":[{"code":"4500408","type":"CDM"},{"code":"0450","type":"RC"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.0,"discounted_cash":502.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42180 REPAIR LAC OF PALATE UP TO 2 CM","code_information":[{"code":"4500409","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42182 REPAIR LAC OF PALATE OVER 2 CM OR COMPLEX","code_information":[{"code":"4500410","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42182","type":"HCPCS"}],"standard_charges":[{"gross_charge":17097.0,"discounted_cash":10258.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42700 INC/DRN ABSCESS,PERITONSILLAR","code_information":[{"code":"4500411","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42809 REMOVAL OF FB PHARYNX","code_information":[{"code":"4500412","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42809","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42960 CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE","code_information":[{"code":"4500413","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":638.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42970 NASOPHARYNGEAL HEM WITH  OR W/O CAUTERY","code_information":[{"code":"4500414","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42970","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROC-PHARX/ADEN/TONSIL","code_information":[{"code":"4500415","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42999","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":316.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43235 EGD, TRANSORAL DIAG W/SPEC COLL","code_information":[{"code":"4500416","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.0,"discounted_cash":1125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43238 UPPER GI ENDOSCOPY W/US FINE NEEDLE BX","code_information":[{"code":"4500417","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1992.0,"discounted_cash":1195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43239 ENDOSCOPY, UGI WITH BIOPSY SINGLE/MULTIPLE","code_information":[{"code":"4500418","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43239","type":"HCPCS"}],"standard_charges":[{"gross_charge":2084.0,"discounted_cash":1250.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43247 ENDOSCOPY, UGI, WITH REMOVAL FB","code_information":[{"code":"4500419","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43247","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1254.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE, STOMACH","code_information":[{"code":"4500422","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2529.0,"discounted_cash":1517.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 45300 PROCTOSIGMOIDOSCOPY,DX WITH OR W/O SPEC","code_information":[{"code":"4500424","type":"CDM"},{"code":"0450","type":"RC"},{"code":"45300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1260.0,"discounted_cash":756.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 45999 UNLISTD PROC-RECTUM REM FECAL IMPACTION","code_information":[{"code":"4500425","type":"CDM"},{"code":"0450","type":"RC"},{"code":"45999","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":574.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 46040 INC/DRN ISCHREC/PERIRECTAL ABSCESS","code_information":[{"code":"4500426","type":"CDM"},{"code":"0450","type":"RC"},{"code":"46040","type":"HCPCS"}],"standard_charges":[{"gross_charge":6873.0,"discounted_cash":4123.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 46050 INC/DRN PERIANAL ABSCESS,SUPFSC","code_information":[{"code":"4500427","type":"CDM"},{"code":"0450","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":3936.0,"discounted_cash":2361.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 46083 INCISION THROMBOSD HEMORRHOID, EXTERNAL","code_information":[{"code":"4500428","type":"CDM"},{"code":"0450","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.0,"discounted_cash":571.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 46320 ENUCL/EXC THROMBOTIC HEMORRHOID,EXT","code_information":[{"code":"4500429","type":"CDM"},{"code":"0450","type":"RC"},{"code":"46320","type":"HCPCS"}],"standard_charges":[{"gross_charge":13933.0,"discounted_cash":8359.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 46600 ANOSCOPY, DIAGNOSTIC","code_information":[{"code":"4500430","type":"CDM"},{"code":"0450","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49002 REOPENING OF RECENT LAPAROTOMY SITE","code_information":[{"code":"4500432","type":"CDM"},{"code":"0450","type":"RC"},{"code":"49002","type":"HCPCS"}],"standard_charges":[{"gross_charge":4140.0,"discounted_cash":2484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49450 REPLC GASTRO/CECO TBE PERC W/FLURO/CONT","code_information":[{"code":"4500434","type":"CDM"},{"code":"0450","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2086.0,"discounted_cash":1251.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51045 CYSTOSTOMY,WITH INSERT URETERAL CATH/STENT","code_information":[{"code":"4500436","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51045","type":"HCPCS"}],"standard_charges":[{"gross_charge":2151.0,"discounted_cash":1290.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51102 ASPIRATION BLADDER WITH INSERT SUPRAP CATH","code_information":[{"code":"4500437","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":8300.0,"discounted_cash":4980.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51701 INSERT NON-INDWELLING BLADDER CATH","code_information":[{"code":"4500439","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":291.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51702 INSERT INDWELLING BLADDER CATH","code_information":[{"code":"4500440","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":585.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51703 INSERT COMPLICATED BLADDER CATH","code_information":[{"code":"4500441","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51705 CHANGE OF CYSTOSTOMY TUBE,SIMPLE","code_information":[{"code":"4500442","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":592.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51710 CHANGE OF CYSTOSTOMY TUBE: COMPLEX","code_information":[{"code":"4500443","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":3095.0,"discounted_cash":1857.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 54220 IRRIG CORPORA CAVERNOSA FOR  PRIAPISM","code_information":[{"code":"4500444","type":"CDM"},{"code":"0450","type":"RC"},{"code":"54220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1193.0,"discounted_cash":715.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 54450 FORESKIN MANIP, INC LYSIS OF ADHESIONS","code_information":[{"code":"4500445","type":"CDM"},{"code":"0450","type":"RC"},{"code":"54450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":793.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 55000 PUNCTURE ASPIRATION OF HYDROCELE RT","code_information":[{"code":"4500446","type":"CDM"},{"code":"0450","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1886.0,"discounted_cash":1131.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 55000 PUNCTURE ASPIRATION OF HYDROCELE LT","code_information":[{"code":"4500447","type":"CDM"},{"code":"0450","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1886.0,"discounted_cash":1131.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 55100 DRAINAGE OF SCROTAL WALL ABSCESS","code_information":[{"code":"4500448","type":"CDM"},{"code":"0450","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":4235.0,"discounted_cash":2541.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE-MALE GENITAL SYS","code_information":[{"code":"4500449","type":"CDM"},{"code":"0450","type":"RC"},{"code":"55899","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 56405 INC/DRN VULVA/PERINEAL ABCESS","code_information":[{"code":"4500450","type":"CDM"},{"code":"0450","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 56420 INS/DRN BARTHOLINS GLAND ABSCESS","code_information":[{"code":"4500451","type":"CDM"},{"code":"0450","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.0,"discounted_cash":550.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 57160 INSERTION OF PESSARY DEVICE","code_information":[{"code":"4500452","type":"CDM"},{"code":"0450","type":"RC"},{"code":"57160","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 57200 COLPOPERINEORHAPHY-SUTURE","code_information":[{"code":"4500453","type":"CDM"},{"code":"0450","type":"RC"},{"code":"57200","type":"HCPCS"}],"standard_charges":[{"gross_charge":4168.0,"discounted_cash":2500.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 57800 DILATE OF CERVICAL CANAL, INSTRUMENTAL","code_information":[{"code":"4500454","type":"CDM"},{"code":"0450","type":"RC"},{"code":"57800","type":"HCPCS"}],"standard_charges":[{"gross_charge":7771.0,"discounted_cash":4662.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 58301 REMOVAL OF INTRAUTERINE DEVICE (IUD)","code_information":[{"code":"4500455","type":"CDM"},{"code":"0450","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":363.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROC,FEMALE GENITAL SYS","code_information":[{"code":"4500456","type":"CDM"},{"code":"0450","type":"RC"},{"code":"58999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1052.0,"discounted_cash":631.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 59409 VAGINAL DELIVERY ONLY","code_information":[{"code":"4500457","type":"CDM"},{"code":"0450","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":5939.0,"discounted_cash":3563.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 59414 DELIVERY OF PLACENTA","code_information":[{"code":"4500458","type":"CDM"},{"code":"0450","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":4920.0,"discounted_cash":2952.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 59812 TX INCOMPLETE AB,ANY TRIMESTER, SURGICAL","code_information":[{"code":"4500459","type":"CDM"},{"code":"0450","type":"RC"},{"code":"59812","type":"HCPCS"}],"standard_charges":[{"gross_charge":7871.0,"discounted_cash":4722.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 61107 TWST DRL HOL-IMP VENT CATH PRS DEV","code_information":[{"code":"4500460","type":"CDM"},{"code":"0450","type":"RC"},{"code":"61107","type":"HCPCS"}],"standard_charges":[{"gross_charge":3516.0,"discounted_cash":2109.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62223 CREAT SHUNT, VENTRICULO-PERITONEAL","code_information":[{"code":"4500461","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62223","type":"HCPCS"}],"standard_charges":[{"gross_charge":3995.0,"discounted_cash":2397.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC","code_information":[{"code":"4500462","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1791.0,"discounted_cash":1074.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62273 INJ EPIDURAL,BLOOD/CLOT PATCH","code_information":[{"code":"4500463","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3065.0,"discounted_cash":1839.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64450 INJ ANESTH AGENT, OTH PERIPH NER/BRCH","code_information":[{"code":"4500468","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":970.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64702 NEUROPLSTY-1 OR BOTH, SAME DIGIT","code_information":[{"code":"4500469","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64702","type":"HCPCS"}],"standard_charges":[{"gross_charge":9620.0,"discounted_cash":5772.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 65205 REMOVE FB,EXT EYE,CONJ SUPER RT","code_information":[{"code":"4500470","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":241.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65205 REMOVE FB,EXT EYE,CONJ SUPER LT","code_information":[{"code":"4500471","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":241.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65205 REMOVE FB,EXT EYE,CONJ SUPER BLT","code_information":[{"code":"4500472","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":593.0,"discounted_cash":355.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 65210 REMOVE FB,EXT EYE,CONJN EMBED RT","code_information":[{"code":"4500475","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":398.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65210 REMOVE FB,EXT EYE,CONJN EMBED LT","code_information":[{"code":"4500476","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":398.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65220 REMOVE FB,EXT EYE,CORN W/O SLIT RT","code_information":[{"code":"4500477","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":336.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65220 REMOVE FB,EXT EYE,CORN W/O SLIT LT","code_information":[{"code":"4500478","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":336.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65220 REMOVE FB,EXT EYE,CORN W/O SLIT BLT","code_information":[{"code":"4500479","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":899.0,"discounted_cash":539.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 65222 REMOVE FB,EXT EYE,CORN W/SLIT RT","code_information":[{"code":"4500480","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":438.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65222 REMOVE FB,EXT EYE,CORN W/SLIT LT","code_information":[{"code":"4500481","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":731.0,"discounted_cash":438.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65222 REMOVE FB,EXT EYE,CORN W/SLIT BLT","code_information":[{"code":"4500482","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":652.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 65800 PARACENTESIS ANT CHAMB EYE/ASPIRATION RT","code_information":[{"code":"4500483","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2418.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65800 PARACENTESIS ANT CHAMB EYE/ASPIRATION LT","code_information":[{"code":"4500484","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":4030.0,"discounted_cash":2418.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65810 PARA EYE ANTERIOR CHAMBER W/REMOVAL RT","code_information":[{"code":"4500487","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65810","type":"HCPCS"}],"standard_charges":[{"gross_charge":5407.0,"discounted_cash":3244.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 65810 PARA EYE ANTERIOR CHAMBER W/REMOVAL LT","code_information":[{"code":"4500488","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65810","type":"HCPCS"}],"standard_charges":[{"gross_charge":5407.0,"discounted_cash":3244.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 67715 CANTHOTOMY","code_information":[{"code":"4500491","type":"CDM"},{"code":"0450","type":"RC"},{"code":"67715","type":"HCPCS"}],"standard_charges":[{"gross_charge":5165.0,"discounted_cash":3099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 67938 REMOVE EMBED FB ,EYELID RT","code_information":[{"code":"4500492","type":"CDM"},{"code":"0450","type":"RC"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 67938 REMOVE EMBED FB ,EYELID LT","code_information":[{"code":"4500493","type":"CDM"},{"code":"0450","type":"RC"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69000 DRN EXT EAR,ABCESS/HEMAT,SIMP RT","code_information":[{"code":"4500494","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":443.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69000 DRN EXT EAR,ABCESS/HEMAT,SIMP LT","code_information":[{"code":"4500495","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":443.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69200 REMOVE FB AUDIT CANAL,W/O GEN ANES RT","code_information":[{"code":"4500496","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69200 REMOVE FB AUDIT CANAL,W/O GEN ANES LT","code_information":[{"code":"4500497","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69200 REMOVE FB AUDIT CANAL,W/O GEN ANES BIL","code_information":[{"code":"4500498","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":375.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC UNLISTED PROCEDURE, MIDDLE EAR","code_information":[{"code":"4500500","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69799","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90471 IMMUNIZATION ADMINISTRAT, ONE VACCINE","code_information":[{"code":"4500501","type":"CDM"},{"code":"0450","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":77.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90472 IMMUNIZATION ADMIN, EACH ADDL VACCINE","code_information":[{"code":"4500502","type":"CDM"},{"code":"0450","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92511 NASOPHARYNGOSCOPY WITH ENDOSCOPE","code_information":[{"code":"4500506","type":"CDM"},{"code":"0450","type":"RC"},{"code":"92511","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92950 CARDIOPULMONARY RESUSCITATION","code_information":[{"code":"4500507","type":"CDM"},{"code":"0450","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":858.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92953 TEMPORARY TRANSCUTANEOUS PACING","code_information":[{"code":"4500508","type":"CDM"},{"code":"0450","type":"RC"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.0,"discounted_cash":653.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99281 ED VISIT LEVEL I","code_information":[{"code":"4500510","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":210.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99282 ED VISIT, LEVEL II","code_information":[{"code":"4500511","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":437.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99283 ED VISIT, LEVEL III","code_information":[{"code":"4500512","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.0,"discounted_cash":745.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99284 ED VISIT, LEVEL IV","code_information":[{"code":"4500513","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1968.0,"discounted_cash":1180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99285 ED VISIT, LEVEL V","code_information":[{"code":"4500514","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":3272.0,"discounted_cash":1963.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99291 CRITICAL CARE FIRST 30-74 MIN","code_information":[{"code":"4500521","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":4504.0,"discounted_cash":2702.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99292 CRITICAL CARE EA ADD 30 MIN","code_information":[{"code":"4500522","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":657.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAUMA CAT 1 WITHOUT PRE-HOSPITAL OR CRITICAL CARE","code_information":[{"code":"4500523","type":"CDM"},{"code":"0681","type":"RC"},{"code":"4500523","type":"HCPCS"}],"standard_charges":[{"gross_charge":9995.0,"discounted_cash":5997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRAUMA CAT 2 WITHOUT PRE-HOSPITAL OR CRITICAL CARE","code_information":[{"code":"4500524","type":"CDM"},{"code":"0681","type":"RC"},{"code":"4500524","type":"HCPCS"}],"standard_charges":[{"gross_charge":7584.0,"discounted_cash":4550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0390 TRAUMA CAT 1 WITH PRE-HOSPITAL AND CRITICAL CARE","code_information":[{"code":"4500527","type":"CDM"},{"code":"0681","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":9995.0,"discounted_cash":5997.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0390 TRAUMA CAT 2 WITH PRE-HOSPITAL AND CRITICAL CARE","code_information":[{"code":"4500528","type":"CDM"},{"code":"0681","type":"RC"},{"code":"G0390","type":"HCPCS"}],"standard_charges":[{"gross_charge":7584.0,"discounted_cash":4550.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29305 APPLICATION OF HIP SPICA CAST ONE LEG -RT","code_information":[{"code":"4500531","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29305 APPLICATION OF HIP SPICA CAST ONE LEG -LT","code_information":[{"code":"4500532","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29325 APPLICATION OF HIP SPICA CAST BOTH LEGS","code_information":[{"code":"4500533","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29325","type":"HCPCS"}],"standard_charges":[{"gross_charge":1828.0,"discounted_cash":1096.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29365 APP OF CYLINDER CAST (THIGH TO ANKLE)RT","code_information":[{"code":"4500534","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29365 APP OF CYLINDER CAST (THIGH TO ANKLE) LT","code_information":[{"code":"4500535","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1222.0,"discounted_cash":733.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 12020 TRMT SPFC WOUND DEHIS,SIM CLOS","code_information":[{"code":"4500536","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.0,"discounted_cash":1267.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27825 CLSD TX TIBIA FX W/MANIP LT","code_information":[{"code":"4500540","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":3447.0,"discounted_cash":2068.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27825 CLSD TX TIBIA FX W/MANIP RT","code_information":[{"code":"4500541","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":3447.0,"discounted_cash":2068.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99465 NEWBORN  RESUSCITATION ED DELIVERY","code_information":[{"code":"4500542","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":822.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96373 THER/PROPHDX INJ;INTRA-ART","code_information":[{"code":"4500543","type":"CDM"},{"code":"0450","type":"RC"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27550 CLSD,KNEE DISLOC,W/O ANES-RT","code_information":[{"code":"4500546","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27550 CLSD,KNEE DISLOC,W/O ANES-LT","code_information":[{"code":"4500547","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 49451 PERC REPLC DUOD/JEJUN TB W","code_information":[{"code":"4500548","type":"CDM"},{"code":"0450","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":2797.0,"discounted_cash":1678.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VAG PACKING NON OB SEP PROC","code_information":[{"code":"4500549","type":"CDM"},{"code":"0450","type":"RC"},{"code":"57180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1688.0,"discounted_cash":1012.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 52281 CYSTO W/ URETHRAL CALIBRATION OR DILATION","code_information":[{"code":"4500551","type":"CDM"},{"code":"0450","type":"RC"},{"code":"52281","type":"HCPCS"}],"standard_charges":[{"gross_charge":4973.0,"discounted_cash":2983.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31613 TRACHEOSTOMA REVISION;SIMP W/O FLAP ROTATION","code_information":[{"code":"4500552","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31613","type":"HCPCS"}],"standard_charges":[{"gross_charge":10342.0,"discounted_cash":6205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97597 SELECT DEBRIDEMENT FIRST 20 SQ CM OR <","code_information":[{"code":"4500553","type":"CDM"},{"code":"0450","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":391.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97598 SELECT DEBRIDEMENT EA ADD 20 SQ CM","code_information":[{"code":"4500554","type":"CDM"},{"code":"0450","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":316.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11045 DEBRIDE SUBQ TISSUE; EA ADD 20 SQ CM","code_information":[{"code":"4500556","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.0,"discounted_cash":603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27252 CLOSED TX HIP DISLOC TRAUMA WITH ANES - RT","code_information":[{"code":"4500560","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3238.0,"discounted_cash":1942.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27252 CLOSED TX HIP DISLOC TRAUMA WITH ANES - LT","code_information":[{"code":"4500561","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3008.0,"discounted_cash":1804.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 92960 CARDIOVERSION ELECTIVE, EXTERNAL","code_information":[{"code":"4500565","type":"CDM"},{"code":"0450","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2319.0,"discounted_cash":1391.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36593 DECLOT BY THROMBOLYTIC IMPLANTED VASC DEV/CATH","code_information":[{"code":"4500566","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1763.0,"discounted_cash":1057.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 54700 I/D EPIDIDYMIS, TESTIS, AND/OR SCROTAL SPACE","code_information":[{"code":"4500568","type":"CDM"},{"code":"0450","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":9421.0,"discounted_cash":5652.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 35207 BLD VSL REP DIR HAND/FINGER","code_information":[{"code":"4500572","type":"CDM"},{"code":"0450","type":"RC"},{"code":"35207","type":"HCPCS"}],"standard_charges":[{"gross_charge":7321.0,"discounted_cash":4392.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49082 ABD PARACENTESIS W/O IMAG GUID","code_information":[{"code":"4500573","type":"CDM"},{"code":"0450","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49083 ABD PARACENTESIS WITH IMAG GUID","code_information":[{"code":"4500574","type":"CDM"},{"code":"0450","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2093.0,"discounted_cash":1255.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23655 CLSD TX SHLDR DISLOC W MANIP W ANES-RT","code_information":[{"code":"4500577","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25535 CLSD TX ULNAR SHAFT FX W MANIPULATION-RT","code_information":[{"code":"4500579","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2105.0,"discounted_cash":1263.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25535 CLSD TX ULNAR SHAFT FX W MANIPULATION-LT","code_information":[{"code":"4500580","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2105.0,"discounted_cash":1263.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20612 ASPIRATE &/OR INJECT GANGLION CYST","code_information":[{"code":"4500581","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":1239.0,"discounted_cash":743.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64405 ANES GREATER OCCIPITAL NERVE - RT","code_information":[{"code":"4500582","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64405 ANES GREATER OCCIPITAL NERVE - LT","code_information":[{"code":"4500583","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64405 ANES GREATER OCCIPITAL NERVE - BILAT","code_information":[{"code":"4500584","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1118.0,"discounted_cash":670.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 54001 SLITTING PREPUCE, DORS OR LAT; EXCEPT NEWBORN","code_information":[{"code":"4500585","type":"CDM"},{"code":"0450","type":"RC"},{"code":"54001","type":"HCPCS"}],"standard_charges":[{"gross_charge":9129.0,"discounted_cash":5477.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 52000 CYSTOURETHROSCOPY","code_information":[{"code":"4500588","type":"CDM"},{"code":"0450","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":5064.0,"discounted_cash":3038.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32554 THORACENTESIS NDL/CATH ASP PLEURL SPC W/O IMG GD-RT","code_information":[{"code":"4500589","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":930.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32554 THORACENTESIS NDL/CATH ASP PLEURL SPC W/O IMG GD-LT","code_information":[{"code":"4500590","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":1550.0,"discounted_cash":930.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD-RT","code_information":[{"code":"4500591","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2978.0,"discounted_cash":1786.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD-LT","code_information":[{"code":"4500592","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2978.0,"discounted_cash":1786.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC W IMG GD-BLT","code_information":[{"code":"4500593","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":4466.0,"discounted_cash":2679.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37197 TRANSCATH RETRIEVAL PERC OF INTRAVASC FB INC IMAG GUID","code_information":[{"code":"4500594","type":"CDM"},{"code":"0450","type":"RC"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":10001.0,"discounted_cash":6000.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32556 PLEURAL DRAIN PERC W/CATH INSERT W/O IMAG GUID-RT","code_information":[{"code":"4500595","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1992.0,"discounted_cash":1195.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32556 PLEURAL DRAIN PERC W/CATH INSERT W/O IMAG GUID-LT","code_information":[{"code":"4500596","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1992.0,"discounted_cash":1195.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32556 PLEURAL DRAIN PERC W/CATH INSERT W/O IMAG GUID-BLT","code_information":[{"code":"4500597","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1992.0,"discounted_cash":1195.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 32557 PLEURAL DRAIN PERC W/CATH INSERT W/IMAG GUID-RT","code_information":[{"code":"4500598","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3141.0,"discounted_cash":1884.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32557 PLEURAL DRAIN PERC W/CATH INSERT W/IMAG GUID-LT","code_information":[{"code":"4500599","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":3141.0,"discounted_cash":1884.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 32557 PLEURAL DRAIN PERC W/CATH INSERT W/IMAG GUID-BLT","code_information":[{"code":"4500600","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":4708.0,"discounted_cash":2824.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 32554 THORACENTESIS NDL/CATH ASP PLEURL SPC W/O IMG GD BLT","code_information":[{"code":"4500602","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2320.0,"discounted_cash":1392.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29126 APPL SHORT ARM SPLINT, DYNAMIC, RT","code_information":[{"code":"4500604","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29126 APPL SHORT ARM SPLINT, DYNAMIC, LT","code_information":[{"code":"4500605","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24620 CLSD TX ELBOW FX/DISLOC W/MANIP - RT","code_information":[{"code":"4500606","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2696.0,"discounted_cash":1617.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24620 CLSD TX ELBOW FX/DISLOC W/MANIP - LT","code_information":[{"code":"4500607","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2696.0,"discounted_cash":1617.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23575 CLOSED TX SHOULDER BLADE FX W/ MANIP","code_information":[{"code":"4500608","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23575","type":"HCPCS"}],"standard_charges":[{"gross_charge":3293.0,"discounted_cash":1975.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24577 CLSD HUMERAL CONDYLAR FX MED/LAT W/MANIP","code_information":[{"code":"4500609","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":3293.0,"discounted_cash":1975.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE LARYNX","code_information":[{"code":"4500610","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31599","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":174.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 42000 DRAINAGE MOUTH ROOF LESION","code_information":[{"code":"4500611","type":"CDM"},{"code":"0450","type":"RC"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":288.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 67700 BLEPHAROTOMY, DRAINAGE OF ABCESS, EYELID-RT-FAC","code_information":[{"code":"4500612","type":"CDM"},{"code":"0450","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1389.0,"discounted_cash":833.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 67700 BLEPHAROTOMY, DRAINAGE OF ABCESS, EYELID-LT-FAC","code_information":[{"code":"4500613","type":"CDM"},{"code":"0450","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1389.0,"discounted_cash":833.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69210 REMOVE IMPACT CERUMEN W/INSTRUMENTS-RT","code_information":[{"code":"4500615","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69210 REMOVE IMPACT CERUMEN W/INSTRUMENTS-LT","code_information":[{"code":"4500616","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69210 REMOVE IMPACT CERUMEN W/INSTRUMENTS-BLT","code_information":[{"code":"4500617","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 11043 DEBRIDE TISSUE/MUSCLE FIRST 20 SQ CM OR <","code_information":[{"code":"4500621","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1468.0,"discounted_cash":880.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12021 TX SUPERF WOUND DEHISC W/PACK","code_information":[{"code":"4500622","type":"CDM"},{"code":"0450","type":"RC"},{"code":"12021","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.0,"discounted_cash":852.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27530 CLSD TX PROX TIBIAL FX WO MANIP RT","code_information":[{"code":"4500652","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":740.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27530 CLSD TX PROX TIBIAL FX WO MANIP LT","code_information":[{"code":"4500653","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.0,"discounted_cash":740.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27530 CLSD TX PROX TIBIAL FX WO MANIP BILAT","code_information":[{"code":"4500654","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1851.0,"discounted_cash":1110.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 51798 BLADDER SCAN (URINE CAPACITY) NON-IMAGING","code_information":[{"code":"4500681","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64400 INJ ANESTH TRIGEMINAL NERVE RT","code_information":[{"code":"4500687","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":435.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64400 INJ ANESTH TRIGEMINAL NERVE LT","code_information":[{"code":"4500688","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":435.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64400 INJ ANESTH TRIGEMINAL NERVE BILAT","code_information":[{"code":"4500689","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.0,"discounted_cash":435.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64420 INJ ANES AGENT INTERCOSTAL NERV SNGL RT","code_information":[{"code":"4500693","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":976.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64420 INJ ANES AGENT INTERCOSTAL NERV SNGL LTT","code_information":[{"code":"4500694","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":976.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64420 INJ ANES AGENT INTERCOSTAL NERV SNGL BILAT","code_information":[{"code":"4500695","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2441.0,"discounted_cash":1464.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64450  INJ ANES AGENT, OTH PERIPH NER/BRCH RT","code_information":[{"code":"4500708","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":823.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64450 INJ ANES AGENT, OTH PERIPH NER/BRCH LT","code_information":[{"code":"4500709","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":823.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64450 INJ ANES AGENT, OTH PERIPH NER/BRCH BILAT","code_information":[{"code":"4500710","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2277.0,"discounted_cash":1366.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 69020 DRAIN EXTERNAL AUDITORY CANAL ABSCESS RT","code_information":[{"code":"4500732","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":1123.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69020 DRAIN EXTERNAL AUDITORY CANAL ABSCESS LT","code_information":[{"code":"4500733","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1872.0,"discounted_cash":1123.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25690 CLSD TX OF WRIST DISLOCATION W/ MANIP-RT","code_information":[{"code":"4500736","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.0,"discounted_cash":4054.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25690 CLSD TX OF WRIST DISLOCATION W/ MANIP-LT","code_information":[{"code":"4500737","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.0,"discounted_cash":4054.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20606 ARTHOCENTESIS, ASPIRATION AND/OR INJ, INT JOINT/BURSA; W US, REC/REPORT -LT","code_information":[{"code":"4500743","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.0,"discounted_cash":1044.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20611 ARTHOCENTESIS, ASPIRATION/INJECT, MAJOR JOINT/BURSA; W US, REC/REPORT -RT","code_information":[{"code":"4500745","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":444.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20611 ARTHOCENTESIS, ASPIRATION/INJECT, MAJOR JOINT/BURSA; W US, REC/REPORT -LT","code_information":[{"code":"4500746","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":444.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20611 ARTHOCENTESIS, ASPIRATION/INJECT, MAJOR JOINT/BURSA; W US, REC/REPORT -BLT","code_information":[{"code":"4500747","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":1109.0,"discounted_cash":665.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE-RT","code_information":[{"code":"4500748","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE-LT","code_information":[{"code":"4500749","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC UNLISTED PROCEDURE-SMALL INTESTINE","code_information":[{"code":"4500750","type":"CDM"},{"code":"0450","type":"RC"},{"code":"44799","type":"HCPCS"}],"standard_charges":[{"gross_charge":4330.0,"discounted_cash":2598.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20610 ARTHROCENT, MAJOR JT/BURSA/GAN; WO GUIDE-RT","code_information":[{"code":"4500751","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 ARTHROCENT, MAJOR JT/BURSA/GAN; WO GUIDE-LT","code_information":[{"code":"4500752","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 ARTHROCENT, MAJOR JT/BURSA/GAN; WO GUIDE-BIL","code_information":[{"code":"4500753","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1930.0,"discounted_cash":1158.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20600 INJ ARTHRO,SM JT/BURSA/GAN W/O US GUIDE-RT","code_information":[{"code":"4500754","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":723.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20600 INJ ARTHRO,SM JT/BURSA/GAN W/O US GUIDE-LT","code_information":[{"code":"4500755","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1205.0,"discounted_cash":723.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20606 ARTHOCENTESIS, ASPIRATION AND/OR INJ, INT JOINT/BURSA; W US, REC/REPORT -RT","code_information":[{"code":"4500757","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.0,"discounted_cash":1044.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 10081 I&D PILONIDAL CYST, COMPLICATED","code_information":[{"code":"4500759","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.0,"discounted_cash":1062.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25675 CLOSED TX DISTAL RADIOULNAR DISLOC W/MANIP","code_information":[{"code":"4500760","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":372.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27552 CLSD TX KNEE DISLOCATION; REQ ANESTHESIA - RT","code_information":[{"code":"4500764","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5972.0,"discounted_cash":3583.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27552 CLSD TX KNEE DISLOCATION; REQ ANESTHESIA - LT","code_information":[{"code":"4500765","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5548.0,"discounted_cash":3328.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69209 REMOVE IMPACT CERUMEN W/LAVAGE-RT","code_information":[{"code":"4500771","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69209 REMOVE IMPACT CERUMEN W/LAVAGE-LT","code_information":[{"code":"4500772","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC UNLISTED PROCEDURE HUMERUS/ELBOW","code_information":[{"code":"4500773","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24999","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.0,"discounted_cash":426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29105 APPLICATION LONG ARM SPLINT BLT","code_information":[{"code":"4500774","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":341.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 69209 REMOVE IMPACTED CERUMEN W/LAVAGE BLT","code_information":[{"code":"4500775","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 45900 REDUC RECTAL PROLAPSE UNDER ANESTHESIA","code_information":[{"code":"4500779","type":"CDM"},{"code":"0450","type":"RC"},{"code":"45900","type":"HCPCS"}],"standard_charges":[{"gross_charge":3141.0,"discounted_cash":1884.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64447 INJECTION ANES AGENT FEMORAL NERVE SINGLE RT","code_information":[{"code":"4500780","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":976.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64447 INJECTION ANES AGENT FEMORAL NERVE SINGLE LT","code_information":[{"code":"4500781","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":976.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64447 INJECTION ANES AGENT FEMORAL NERVE SINGLE BILAT","code_information":[{"code":"4500782","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":976.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 23675 CLSD TX SHLD DISL, SURG/ANATOM NECK FX, W MAN-RT","code_information":[{"code":"4500785","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3868.0,"discounted_cash":2320.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23675 CLSD TX SHLD DISL, SURG/ANATOM NECK FX, W MAN-LT","code_information":[{"code":"4500786","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3868.0,"discounted_cash":2320.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 45915 REMOVAL OF FECAL IMPACTION OR FB (SEPARATE PROCEDURE) UNDER ANESTHESIA","code_information":[{"code":"4500787","type":"CDM"},{"code":"0450","type":"RC"},{"code":"45915","type":"HCPCS"}],"standard_charges":[{"gross_charge":7945.0,"discounted_cash":4767.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62320 EPIDURAL NJX, CERV/THORACIC W/O IMAGING","code_information":[{"code":"4500790","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":5956.0,"discounted_cash":3573.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62321 EPIDURAL NJX,  CERV/THORACIC, WITH IMAGING","code_information":[{"code":"4500791","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":8277.0,"discounted_cash":4966.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62326 EPIDURAL INFUSION, LUMBAR/SACRAL - NO IMAGING","code_information":[{"code":"4500792","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":5670.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62327 EPIDURAL INFUSION, LUMBAR/SACRAL - WITH IMAGING","code_information":[{"code":"4500793","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":9061.0,"discounted_cash":5436.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99151 MODERATE SEDATION, SAME QHP, 1ST 15 MIN, <5 YRS","code_information":[{"code":"4500794","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99152 MODERATE SEDATION, SAME QHP, 1ST 15 MIN, 5/>YRS","code_information":[{"code":"4500795","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1025.0,"discounted_cash":615.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99153 MODERATE SEDATION, SAME QHP, EACH ADDL 15 MIN","code_information":[{"code":"4500796","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":569.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99155 MODERATE SEDATION, OTHER QHP, 1ST 15 MIN, <5 YRS","code_information":[{"code":"4500797","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":564.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99156 MODERATE SEDATION, OTHER QHP, 1ST 15 MIN, 5/>YRS","code_information":[{"code":"4500798","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":564.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99157 MODERATE SEDATION, OTHER QHP, EACH ADDL 15 MIN","code_information":[{"code":"4500799","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":566.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27197 CLSD POST PELVIC RING FX/DISL,W/O MANIP","code_information":[{"code":"4500800","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":4096.0,"discounted_cash":2457.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27198 CLSD POST PELVIC RING FX/DISL,W/MANIP","code_information":[{"code":"4500801","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":6489.0,"discounted_cash":3893.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62322 EPIDURAL NJX, LUMBAR/SACRAL W/O IMAGING","code_information":[{"code":"4500802","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":5178.0,"discounted_cash":3106.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62323 EPIDURAL NJX, LUMBAR/SACRAL WITH IMAGING","code_information":[{"code":"4500803","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":8277.0,"discounted_cash":4966.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11200 RMVL OF SKIN TAG, UP TO 15","code_information":[{"code":"4500821","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 52310 CYSTOURETHROSCOPY W/ FB/CALCULUS/STENT REMOVAL","code_information":[{"code":"4500827","type":"CDM"},{"code":"0450","type":"RC"},{"code":"52310","type":"HCPCS"}],"standard_charges":[{"gross_charge":7247.0,"discounted_cash":4348.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION; SNGL LESION","code_information":[{"code":"4500832","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10021 FINE NEEDLE ASPIRATION BX, W/O IMAGING GUIDE; FIRST LESION","code_information":[{"code":"4500833","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10021","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.0,"discounted_cash":328.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10004 FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL","code_information":[{"code":"4500834","type":"CDM"},{"code":"0450","type":"RC"},{"code":"10004","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36572 PICC LINE INSERTION W/O SUBQ PORT < 5 YRS /INCL IMAGING","code_information":[{"code":"4500835","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36572","type":"HCPCS"}],"standard_charges":[{"gross_charge":10431.0,"discounted_cash":6258.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36573 PICC LINE INSERTIONW/O SUBQ PORT 5 YR/> / INCL IMAGING","code_information":[{"code":"4500836","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":6874.0,"discounted_cash":4124.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43762 REPLACE PERC G TUBE, NO TRACT REVISION, NO IMAGING","code_information":[{"code":"4500837","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":527.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 43763 REPLACE PERC G TUBE WITH TRACT REVISION, NO IMAGING","code_information":[{"code":"4500838","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27842 CLSD TX ANKLE DISLOCATION W/ANES RT","code_information":[{"code":"4500839","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":4380.0,"discounted_cash":2628.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27842 CLSD TX ANKLE DISLOCATION W/ANES LT","code_information":[{"code":"4500840","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":4380.0,"discounted_cash":2628.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28288 OSTECTOMY PARTIAL EXOSTC/CONDTL METATARSEL HEAD RT","code_information":[{"code":"4500841","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28288","type":"HCPCS"}],"standard_charges":[{"gross_charge":4491.0,"discounted_cash":2694.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28288 OSTECTOMY PARTIAL EXOSTC/CONDTL METATARSEL HEAD LT","code_information":[{"code":"4500842","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28288","type":"HCPCS"}],"standard_charges":[{"gross_charge":4491.0,"discounted_cash":2694.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36625 INSERTION OF CATHETER, ARTERIAL","code_information":[{"code":"4500846","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36625","type":"HCPCS"}],"standard_charges":[{"gross_charge":791.0,"discounted_cash":474.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27532 CLOSED TREAT TIBIAL FRACT, PROXIMAL; W OR WO MANIP, W TRACTION-RT","code_information":[{"code":"4500847","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":7553.0,"discounted_cash":4531.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27532 CLOSED TREAT TIBIAL FRACT, PROXIMAL; W OR WO MANIP, W TRACTION-LT","code_information":[{"code":"4500848","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":7553.0,"discounted_cash":4531.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32100 THORACOTOMY WITH EXPLORATION","code_information":[{"code":"4500852","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.0,"discounted_cash":792.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62328 DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"4500857","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2699.0,"discounted_cash":1619.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64999 UNLISTED PROCEDURE; NERVOUS SYSTEM","code_information":[{"code":"4500858","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.0,"discounted_cash":538.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33016 PERICARDIOCENTESIS, INCLUDING IMAGING GUIDANCE WHEN PERFORMED","code_information":[{"code":"4500859","type":"CDM"},{"code":"0450","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":3846.0,"discounted_cash":2307.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11422 EXCISION BENIGN LESION W MARGIN, EXC SKIN TAG, S/N/H/F/G; 1.1-2.0CM","code_information":[{"code":"4500862","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"4500863","type":"CDM"},{"code":"0450","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 19020 MASTOTOMY W/ EXPLORATION/DRAINAGE ABSCESS DEEP","code_information":[{"code":"4500865","type":"CDM"},{"code":"0450","type":"RC"},{"code":"19020","type":"HCPCS"}],"standard_charges":[{"gross_charge":4912.0,"discounted_cash":2947.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20600 ARTHROCENTESIS ASPIRATION &/OR INJ SM JT/BURSA W/O US GUIDE","code_information":[{"code":"4500866","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"discounted_cash":671.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20605 ARTHROCENTESIS  ASPIRATION &/OR INJ MED JT/BURSA W/O US GUIDE","code_information":[{"code":"4500868","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1182.0,"discounted_cash":709.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20606 ARTHROCENTESIS ASPIRATION &/OR INJ MED JT/BURSA WITH US GUIDE","code_information":[{"code":"4500869","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1740.0,"discounted_cash":1044.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20610 ARTHROCENTESIS ASPIRATION &/OR INJ MAJR JT/BURSA W/O US GUIDE","code_information":[{"code":"4500870","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1793.0,"discounted_cash":1075.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20611 ARTHROCENTESIS ASPIRATION &/OR INJ MAJR JT/BURSA WITH US GUIDE","code_information":[{"code":"4500871","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":1031.0,"discounted_cash":618.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21480 CLSD TX TEMPOROMANDIBULAR DISLOC 1ST/SBSQ","code_information":[{"code":"4500874","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1192.0,"discounted_cash":715.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23330 REMOVE FB SHOULDER SUBCUTANEOUS","code_information":[{"code":"4500875","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2648.0,"discounted_cash":1588.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23500 CLSD TX CLAVICAL FX W/O MANIP","code_information":[{"code":"4500876","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23570 CLSD TX SCAPULAR FX W/O MANIP","code_information":[{"code":"4500882","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":523.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23605 CLSD TX PROXIMAL HUMERAL FX WITH MANIP","code_information":[{"code":"4500884","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":4121.0,"discounted_cash":2472.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23620 CLSD TX GREATER HUMERAL TUB FX W/O MANIP","code_information":[{"code":"4500885","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":798.0,"discounted_cash":478.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23650 CLSD TX SHOULDER DSLC WITH MANIP W/O ANES","code_information":[{"code":"4500886","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.0,"discounted_cash":1279.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23665 CLSD TX SHOULDER DISLC W/FX GREATER HUMERAL TUB WITH MANIP","code_information":[{"code":"4500888","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":2206.0,"discounted_cash":1323.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23675 CLSD TX SHOULDER DISLC W/SURG OR ANATOMICAL NECK FX WITH MANIP","code_information":[{"code":"4500889","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23675","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":2155.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23931 INCISION & DRAINAGE UPPER ARM/ELBOW BURSA","code_information":[{"code":"4500890","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":3436.0,"discounted_cash":2061.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24500 CLSD TX HUMERAL SHAFT FX W/O MANIP","code_information":[{"code":"4500892","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":945.0,"discounted_cash":567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24505 CLSD TX HUMERAL SHAFT FX, W/WO SKELETAL TRACT, WITH MANIP","code_information":[{"code":"4500893","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24530 CLSD TX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANIP","code_information":[{"code":"4500894","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24535 CLSD TX CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX WITH MANIP","code_information":[{"code":"4500895","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2705.0,"discounted_cash":1623.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24560 CLSD HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANIP","code_information":[{"code":"4500896","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":523.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24565 CLSD HUMERAL EPICONDYLAR FX MEDIAL/LAT WITH MANIP","code_information":[{"code":"4500897","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24600 CLSD TX ELBOW DISLOCATION W/O ANES","code_information":[{"code":"4500899","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":518.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24620 CLSD TX ELBOW FX DISLOCATION W/ MANIP","code_information":[{"code":"4500901","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2696.0,"discounted_cash":1617.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24640 CLSD TX RADL HEAD SUBLXTJ CHLD NURSEMAID ELBOW WITH MANIP","code_information":[{"code":"4500902","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":864.0,"discounted_cash":518.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24650 CLSD TX RADL HEAD/NECK FX, W/O MANIP","code_information":[{"code":"4500903","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24655 CLSD TX RADL HEAD/NECK FX WITH MANIP","code_information":[{"code":"4500904","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24655","type":"HCPCS"}],"standard_charges":[{"gross_charge":2308.0,"discounted_cash":1384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24675 CLSD TX ULNAR FX PROXIMAL END WITH MANIP","code_information":[{"code":"4500906","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25500 CLSD TX RADL SHAFT FX W/O MANIP","code_information":[{"code":"4500908","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25505 CLSD TX RADL SHAFT FX WITH MANIP","code_information":[{"code":"4500909","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2215.0,"discounted_cash":1329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25520 CLSD TX RADL SHAFT FX/DISLOCATE RADIOULNAR JOINT","code_information":[{"code":"4500910","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25530 CLSD TX ULNAR SHAFT FX W/O MANIP","code_information":[{"code":"4500911","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25530","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25535 CLSD TX ULNAR SHAFT FX WITH MANIP","code_information":[{"code":"4500912","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":1173.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25560 CLSD TX RADL & ULNAR FX W/O MANIP","code_information":[{"code":"4500913","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25565 CLSD TX RADL & ULNAR FX WITH MANIP","code_information":[{"code":"4500914","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1066.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25600 CLSD TX DISTL RADL FX OR EPIPHYSL SEPARATE W/O MANIP","code_information":[{"code":"4500915","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25605 CLSD TX DISTL RADL FX OR EPIPHYSL SEPARATE, INCL FRACT ULNA WITH MANIP","code_information":[{"code":"4500916","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":2391.0,"discounted_cash":1434.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25622 CLSD TX CARPAL SCAPH/NAVICULAR FX W/O MANIP","code_information":[{"code":"4500917","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25624 CLSD TX CARPAL SCAPH/NAVICULAR FX WITH MANIP","code_information":[{"code":"4500918","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":964.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25630 CLSD TX CARPAL (NO SCAPHOID/NAVICULAR) FX W/O MANIP, EA BONE","code_information":[{"code":"4500919","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":658.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25650 CLSD TX ULNAR STYLOID FX","code_information":[{"code":"4500920","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25690 CLSD TX WRIST DISLOCATION W/ MANIP","code_information":[{"code":"4500921","type":"CDM"},{"code":"0450","type":"RC"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":6277.0,"discounted_cash":3766.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26350 REPAIR FINGER/HAND TENDON, PRIME/SECOND W/O FREE GRAFT, EA TENDON","code_information":[{"code":"4500922","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":7106.0,"discounted_cash":4263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26600 CLSD TX METACARPAL FX W/O MANIP, EA BONE","code_information":[{"code":"4500923","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":523.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26605 CLSD TX METACARPAL FX, SINGLE; WITH MANIP, EA BONE","code_information":[{"code":"4500924","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.0,"discounted_cash":692.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26641 CLSD TX CARPO/METACARPAL DISLOCATION THUMB WITH MANIP","code_information":[{"code":"4500925","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26641","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26645 CLSD TX CARPO/METACARPAL FX DISLOCATION THUMB WITH MANIP","code_information":[{"code":"4500926","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26670 CLSD TX CARPO/METACARPAL DISLOCATE (NO THUMB) W/ MANIP EA JNT W/O ANES","code_information":[{"code":"4500927","type":"CDM"},{"code":"0450","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27220 CLSD TX ACETABULUM HIP/SOCKET FX, W/O MANIP","code_information":[{"code":"4500928","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27238 CLSD TX INTER/PERI/SUBTROCHANTERIC FEMORAL FX W/O MANIP","code_information":[{"code":"4500929","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":3535.0,"discounted_cash":2121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27250 CLSD TX HIP DISLOCATION, TRAUMA, W/O ANES","code_information":[{"code":"4500931","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27252 CLSD TX HIP DISLOCATION, TRAUMA, WITH ANES","code_information":[{"code":"4500932","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":3008.0,"discounted_cash":1804.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27265 CLSD TX POST HIP ARTHROPLASTY DISLOCATION W/O ANES","code_information":[{"code":"4500934","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27266 CLSD TX POST HIP ARTHROPLASTY DISLOCATION WITH ANES","code_information":[{"code":"4500935","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":2566.0,"discounted_cash":1539.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27502 CLSD TX FEMORAL SHAFT FX, W/ W/O SKIN/SKELETAL TRACT WITH MANIP","code_information":[{"code":"4500938","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":4319.0,"discounted_cash":2591.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27508 CLSD TX FEMORAL FX, DISTAL END, MEDIAL/CONDYLE W/O MANIP","code_information":[{"code":"4500940","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27510 CLSD TX FEMORAL FX, DISTAL END, MEDIAL OR LATERAL CONDYLE WITH MANIP","code_information":[{"code":"4500941","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27520 CLSD TX PATELLAR FX W/O MANIP","code_information":[{"code":"4500943","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.0,"discounted_cash":692.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27530 CLSD TX TIBIAL FX PROXIMAL W/O MANIP","code_information":[{"code":"4500944","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":1032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27532 CLSD TX TIBIAL FX PROXIMAL, W/SKELETAL TRACT, W/WO MANIP","code_information":[{"code":"4500945","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":7017.0,"discounted_cash":4210.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27550 CLSD TX KNEE DISLOCATION W/O ANES","code_information":[{"code":"4500947","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":319.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27552 CLSD TX KNEE DISLOCATION WITH ANES","code_information":[{"code":"4500948","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5548.0,"discounted_cash":3328.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27560 CLSD TX KNEECAP/PATELLAR DISLOCATION W/O ANES","code_information":[{"code":"4500949","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27750 CLSD TX TIBIAL SHAFT FX W/O MANIP","code_information":[{"code":"4500950","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27752 CLSD TX TIBIAL SHAFT FX WITH MANIP","code_information":[{"code":"4500951","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":2832.0,"discounted_cash":1699.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27760 CLSD TX MEDIAL MALLEOUS FX W/O MANIP","code_information":[{"code":"4500952","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27762 CLSD TX KNEECAP/PATELLAR DISLOCATION W/ANES","code_information":[{"code":"4500953","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":2922.0,"discounted_cash":1753.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27780 CLSD TX PROXIMAL FIBULA/SHFT FX W/O MANIP","code_information":[{"code":"4500954","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1028.0,"discounted_cash":616.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27781 CLSD TX PROXIMAL FIBULA/SHFT FX WITH MANIP","code_information":[{"code":"4500955","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6977.0,"discounted_cash":4186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27786 CLSD TX DISTAL FIBULAR FX (LATERAL MALLEOLUS) W/O MANIP","code_information":[{"code":"4500956","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":658.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27788 CLSD TX DISTAL FIBULAR FX (LATERAL MALLEOLUS) WITH MANIP","code_information":[{"code":"4500957","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":831.0,"discounted_cash":498.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27808 CLSD TX BIMALLEOLAR ANKLE FX W/O MANIP","code_information":[{"code":"4500958","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":492.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27810 CLSD TX BIMALLEOLAR ANKLE FX WITH MANIP","code_information":[{"code":"4500959","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27816 CLSD TX TRIMALLIOLA ANKLE FX W/O MANIP","code_information":[{"code":"4500960","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27818 CLSD TX TRIMALLIOLA ANKLE FX WITH MANIP","code_information":[{"code":"4500961","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1680.0,"discounted_cash":1008.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27824 CLSD TX WGT BEAR ARTIC DISTAL TIBIA FX W/O MANIP W/WO ANES","code_information":[{"code":"4500962","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":330.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27825 CLSD TX WGT BEAR ARTIC DISTAL TIBIA FX W/SKEL TRAC WITH MANIP W/WO ANES","code_information":[{"code":"4500963","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":3202.0,"discounted_cash":1921.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27830 CLSD TX PROXIMAL TIBIOFIBULAR JOINT DISLOCATION W/O ANES","code_information":[{"code":"4500964","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27830","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27840 CLSD TX ANKLE DISLOCATION W/O ANES","code_information":[{"code":"4500965","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27842 CLSD TX ANKLE DISLOCATION W/WO SKEL FIXATION W/ANES","code_information":[{"code":"4500966","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":4069.0,"discounted_cash":2441.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28190 REMOVE FB FOOT SUBCUTANEOUS","code_information":[{"code":"4500967","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":2905.0,"discounted_cash":1743.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28192 REMOVE FB FOOT DEEP","code_information":[{"code":"4500968","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":6279.0,"discounted_cash":3767.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28288 OSTECTOMY PARTIAL EXOSTC/CONDTL METATARSEL HEAD, EA","code_information":[{"code":"4500969","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28288","type":"HCPCS"}],"standard_charges":[{"gross_charge":4172.0,"discounted_cash":2503.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28400 CLSD TX CALCANEAL FX W/O MANIP","code_information":[{"code":"4500970","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":658.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28430 CLSD TX TALUS FRACT W/O MANIP","code_information":[{"code":"4500971","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28435 CLSD TX TALUS FRACT WITH MANIP","code_information":[{"code":"4500972","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":3373.0,"discounted_cash":2023.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28490 CLSD TX GRT TOE FX, PHALANX OR PHALANGES W/O MANIP","code_information":[{"code":"4500973","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28495 CLSD TX GRT TOE FX, PHALANX OR PHALANGES WITH MANIP","code_information":[{"code":"4500974","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28495","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":361.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29065 APPLICATION OF CAST, LONG ARM (SHOULDER-HAND)","code_information":[{"code":"4500979","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29075 APPLICATION OF CAST, FOREARM (ELBOW-FINGER)","code_information":[{"code":"4500980","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29085 APPLICATION OF CAST, HAND & LOWER FORARM (GUANTLET)","code_information":[{"code":"4500981","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.0,"discounted_cash":309.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29105 APPLICATION OF SPLINT, LONG ARM (SHOULDER-HAND)","code_information":[{"code":"4500982","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":227.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29125 APPLICATION OF SPLINT, SHORT ARM (FOREARM-HAND) SATIC","code_information":[{"code":"4500983","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29126 APPLICATION OF SPLINT, SHORT ARM (FOREARM-HAND) DYNAMIC","code_information":[{"code":"4500984","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29126","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29240 STRAPPING OF SHOULDER","code_information":[{"code":"4500985","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29260 STRAPPING OF ELBOW OR WRIST","code_information":[{"code":"4500986","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29260","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29280 STRAPPING OF HAND OR FINGER","code_information":[{"code":"4500987","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29305 APPLICATION OF HIP SPICA CAST, ONE LEG","code_information":[{"code":"4500988","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29305","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29345 APPLICATION OF LONG LEG CAST (THIGH TO TOE)","code_information":[{"code":"4500989","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29365 APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)","code_information":[{"code":"4500990","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29405 APPLICATION OF SHORT LEG CAST (BELOW KNEE-TOE)","code_information":[{"code":"4500991","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29425 APPLICATION OF SHORT LEG CAST WALKING/AMBULATORY","code_information":[{"code":"4500992","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29505 APPLICATION OF LONG LEG SPLINT (THIGH ANKLE/TOES)","code_information":[{"code":"4500994","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29515 APPLICATION OF SHORT LEG SPLINT (CALF-FOOT)","code_information":[{"code":"4500995","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29530 STRAPPING OF KNEE","code_information":[{"code":"4500997","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29540 STRAPPING OF ANKLE &/FOOT","code_information":[{"code":"4500998","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29700 REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST","code_information":[{"code":"4501001","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29700","type":"HCPCS"}],"standard_charges":[{"gross_charge":403.0,"discounted_cash":241.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29705 REMOVAL/BIVALVING FULL ARM/FULL LEG CAST","code_information":[{"code":"4501002","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29705","type":"HCPCS"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":421.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32551 TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"4501003","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":1862.0,"discounted_cash":1117.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32554 THORACENTESIS NDL/CATH ASP PLEURL SPC W/O IMG GUIDE","code_information":[{"code":"4501004","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":1293.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32555 THORACENTESIS NDL/CATH ASP PLEURL SPC WITH IMG GUIDE","code_information":[{"code":"4501005","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":4150.0,"discounted_cash":2490.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32556 PLEURAL DRAIN PERC W/CATH INSERT W/O IMAG GUIDE","code_information":[{"code":"4501006","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32556","type":"HCPCS"}],"standard_charges":[{"gross_charge":1992.0,"discounted_cash":1195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 32557 PLEURAL DRAIN PERC W/CATH INSERT WITH IMAG GUIDE","code_information":[{"code":"4501007","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":2918.0,"discounted_cash":1750.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36011 SELECTIVE CATH PLACEMENT VENOUS SYSTM, 1ST ORDER BRANCH","code_information":[{"code":"4501008","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.0,"discounted_cash":1620.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 55000 PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS W W/O MED INJ","code_information":[{"code":"4501009","type":"CDM"},{"code":"0450","type":"RC"},{"code":"55000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.0,"discounted_cash":1051.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64400 INJ ANES AGENT &/OR STEROID TRIGEMINAL NERVE, EA BRANCH","code_information":[{"code":"4501010","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64420 INJ ANES AGENT &/OR STEROID INTERCOSTAL NERVE SINGLE LVL","code_information":[{"code":"4501013","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":976.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64430 INJ ANES AGENT &/OR STEROID PUDENDAL NERVE","code_information":[{"code":"4501016","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2153.0,"discounted_cash":1291.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64447 INJ ANES AGENT &/OR STEROID FEMORAL NERVE W/ IMG","code_information":[{"code":"4501018","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":976.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64450 INJ ANES AGENT &/OR STEROID OTHER PERIPHERAL NERVE/BRANCH","code_information":[{"code":"4501019","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 65205 REMOVE FB EYE CONJUNCTIVAL SUPERFICIAL","code_information":[{"code":"4501025","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 65210 REMOVE FB EYE EXTERNAL CONJUNCTIVAL EMBEDDED NONPERF","code_information":[{"code":"4501026","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65210","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":369.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 65220 REMOVE FB EYE CORNEAL W/O SLIT LAMP","code_information":[{"code":"4501027","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.0,"discounted_cash":501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 65222 REMOVE FB EYE CORNEAL WITH SLIT LAMP","code_information":[{"code":"4501028","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":1011.0,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 65800 PARACENTESIS ANTERIOR CHAMBER OF EYE/ASPIRATION AQUEOUS SPX","code_information":[{"code":"4501029","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3745.0,"discounted_cash":2247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 65810 PARACENTESIS ANTERIOR CHAMBER, REMOVAL VITREOUS W/WO AIR INJ","code_information":[{"code":"4501030","type":"CDM"},{"code":"0450","type":"RC"},{"code":"65810","type":"HCPCS"}],"standard_charges":[{"gross_charge":5024.0,"discounted_cash":3014.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 67700 BLEPHAROTOMY, DRAINAGE OF ABCESS, EYELID","code_information":[{"code":"4501032","type":"CDM"},{"code":"0450","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1291.0,"discounted_cash":774.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 67938 REMOVE FB EYELID EMBEDDED","code_information":[{"code":"4501035","type":"CDM"},{"code":"0450","type":"RC"},{"code":"67938","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":492.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69000 DRAIN EXTERNAL EAR ABCESS/HEMATOMA SIMPLE","code_information":[{"code":"4501036","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":443.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69020 DRAIN EXTERNAL AUDITORY CANAL ABSCESS","code_information":[{"code":"4501037","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":1043.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69200 REMOVE FB AUDITORY CANAL W/O ANES","code_information":[{"code":"4501038","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69209 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG","code_information":[{"code":"4501039","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION","code_information":[{"code":"4501040","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.0,"discounted_cash":353.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21451 CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION","code_information":[{"code":"4501042","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21451","type":"HCPCS"}],"standard_charges":[{"gross_charge":3506.0,"discounted_cash":2103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41821 OPRCULECTOMY EXC PRICORONAL TISSUE","code_information":[{"code":"4501043","type":"CDM"},{"code":"0450","type":"RC"},{"code":"41821","type":"HCPCS"}],"standard_charges":[{"gross_charge":3506.0,"discounted_cash":2103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21110 APPL INTERDENTAL FIXATION DEVICE NON FRACTURE OR DISLOCATE INCL REMOVAL","code_information":[{"code":"4501044","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21110","type":"HCPCS"}],"standard_charges":[{"gross_charge":3506.0,"discounted_cash":2103.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62230 REPLACE/REVISE CEREBROSPINAL FLUID SHUNT, OBSTRUCTED VALVE, DISTAL CATH","code_information":[{"code":"4501049","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62230","type":"HCPCS"}],"standard_charges":[{"gross_charge":16765.0,"discounted_cash":10059.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20526 INJECTION THERAPEUTIC CARPAL TUNNEL","code_information":[{"code":"4501050","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.0,"discounted_cash":447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27768 CLSD TX POSTERIOR MALL FX W/MAN","code_information":[{"code":"4501054","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4045.0,"discounted_cash":2427.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21440 CLSD TX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX, SEPARATE PROCEDURE","code_information":[{"code":"4501055","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21440","type":"HCPCS"}],"standard_charges":[{"gross_charge":7944.0,"discounted_cash":4766.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62252 REPROGRAMMING OF CEREBROSPINAL FLUID SHUNT","code_information":[{"code":"4501056","type":"CDM"},{"code":"0450","type":"RC"},{"code":"62252","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":442.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28575 CLSD TX TALOTARSAL JT DISLOC W ANESTH","code_information":[{"code":"4501092","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":6813.0,"discounted_cash":4087.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92587 DISTORT PROD EVOKED OTOACOUSTIC EMISSIONS LTD","code_information":[{"code":"4710024","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92587","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DISPENSING FEE FOR MONAURAL ANY TYPE","code_information":[{"code":"4710063","type":"CDM"},{"code":"0470","type":"RC"},{"code":"V5241","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92651 AUDIO EVOKED POTENT HEARING STATUS DETER BROADBAND STIMULI I&R","code_information":[{"code":"4710099","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92651","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":246.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92652 AUDIO EVOKED POTENT THRESHOLD ESTIMATION MULT FREQ I&R","code_information":[{"code":"4710100","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":614.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92653 AUDIO EVOKED POTENT NEURODIAGNOSTIC I&R","code_information":[{"code":"4710101","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92653","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":614.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92622 DIAG ANALYSIS AUD OSSEO SOUND PROCESSR 1ST 60 MIN","code_information":[{"code":"4710109","type":"CDM"},{"code":"0470","type":"RC"},{"code":"92622","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92623 DIAG ANALYSIS AUD OSSEO SOUND PROCESSR ADDL 15 MIN EA","code_information":[{"code":"4710110","type":"CDM"},{"code":"0470","type":"RC"},{"code":"92623","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92650 AUDIO EVOKED POTENT SCREEN POTENTIAL BROADBAND STIMULI AUTO ALYS","code_information":[{"code":"4710113","type":"CDM"},{"code":"0471","type":"RC"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":452.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33215 REPOS PREVIOUS IMP PACER/DEFIB&/OR LEAD","code_information":[{"code":"4800001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":8260.0,"discounted_cash":4956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33224 INSERT ELECTRODE FOR LV PACE TO PACER","code_information":[{"code":"4800002","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33224","type":"HCPCS"}],"standard_charges":[{"gross_charge":51544.0,"discounted_cash":30926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33225 INSERT ELECTRODE TO NEW CARDIO-DEFIB","code_information":[{"code":"4800003","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":51544.0,"discounted_cash":30926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33226 REPOS PREVIOUS IMPLANTED ELECTRODE","code_information":[{"code":"4800004","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33226","type":"HCPCS"}],"standard_charges":[{"gross_charge":4885.0,"discounted_cash":2931.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33240 INSERT SINGLE CHAMBER ICD GENERATOR","code_information":[{"code":"4800006","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33240","type":"HCPCS"}],"standard_charges":[{"gross_charge":40337.0,"discounted_cash":24202.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33249 INSERT/REP LEAD & INS GEN FOR SGL CHM ICD","code_information":[{"code":"4800007","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":44680.0,"discounted_cash":26808.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL OF IAB, PERC","code_information":[{"code":"4800009","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33968","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":219.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92960 CARDIOVERSION ELECTIVE, EXTERNAL","code_information":[{"code":"4800011","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.0,"discounted_cash":874.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92953 TEMPORARY TRANSCUTANEOUS PACING","code_information":[{"code":"4800012","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92953","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":751.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92961 CARDIOVERSION ELECTIVE, INTERNAL","code_information":[{"code":"4800013","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92961","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.0,"discounted_cash":876.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC BALLOON VALVULOPLASTY, AORTIC VALV","code_information":[{"code":"4800036","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92986","type":"HCPCS"}],"standard_charges":[{"gross_charge":18075.0,"discounted_cash":10845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC BALLOON VALVULOPLASTY, MITRAL VALV","code_information":[{"code":"4800037","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92987","type":"HCPCS"}],"standard_charges":[{"gross_charge":18075.0,"discounted_cash":10845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC BALLOON VALVULOPLASTY, PULM VALV","code_information":[{"code":"4800038","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92990","type":"HCPCS"}],"standard_charges":[{"gross_charge":18075.0,"discounted_cash":10845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PTA PULMONARY ARTERY, SINGLE VESSEL","code_information":[{"code":"4800046","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92997","type":"HCPCS"}],"standard_charges":[{"gross_charge":11466.0,"discounted_cash":6879.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PTA PULMONARY ARTERY, EA ADDL VESSEL","code_information":[{"code":"4800047","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92998","type":"HCPCS"}],"standard_charges":[{"gross_charge":12425.0,"discounted_cash":7455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93017 CARDIO STRESS TEST TRACING ONLY","code_information":[{"code":"4800048","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.0,"discounted_cash":951.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93503 INSERT/PLACEMENT SWAN-GANZ CATH","code_information":[{"code":"4800050","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93503","type":"HCPCS"}],"standard_charges":[{"gross_charge":2988.0,"discounted_cash":1792.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93505 ENDOMYCARDIAL BIOPSY","code_information":[{"code":"4800051","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93505","type":"HCPCS"}],"standard_charges":[{"gross_charge":6542.0,"discounted_cash":3925.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93571 INTRAVASC FLOW/PRESSUR CORON INIT VESSEL","code_information":[{"code":"4800072","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93571","type":"HCPCS"}],"standard_charges":[{"gross_charge":4085.0,"discounted_cash":2451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93572 INTRAVASC FLOW/PRESS CORON EA ADD VESSEL","code_information":[{"code":"4800073","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93572","type":"HCPCS"}],"standard_charges":[{"gross_charge":2886.0,"discounted_cash":1731.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ASD SEPTAL DEFECT OCCLUDER","code_information":[{"code":"4800074","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93580","type":"HCPCS"}],"standard_charges":[{"gross_charge":69085.0,"discounted_cash":41451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93650 INTRACARDIAC CATH ABLATION AV NODE","code_information":[{"code":"4800076","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93650","type":"HCPCS"}],"standard_charges":[{"gross_charge":9206.0,"discounted_cash":5523.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0269 PLACEMENT OF OCCLUSIVE DEV ART/VEIN","code_information":[{"code":"4800080","type":"CDM"},{"code":"0481","type":"RC"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.0,"discounted_cash":596.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92973 PERC TRANSLUMINAL CORONARY THROMBECTY","code_information":[{"code":"4800087","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":7889.0,"discounted_cash":4733.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92950 CARDIOPULMONARY RESUSCITATION","code_information":[{"code":"4800088","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":858.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93279 EVAL W/ADJST SNGL LEAD OR LEADLESS PACMAKER SYSTEM / 1 CARD CHMBR","code_information":[{"code":"4800089","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93279","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93280 EVAL W/ADJST DUAL LEAD PACEMAKER SYSTEM","code_information":[{"code":"4800090","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93281 EVAL W/ADJST MULTIPLE LEAD PACMKR SYSTM","code_information":[{"code":"4800091","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93281","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93282 EVAL W/ADUST SINGLE LEAD IMPLT CARDVRT-DFIB","code_information":[{"code":"4800092","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93282","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93283 EVAL W/ADJST DUAL LEAD IMPLT CARDIO-DFIB","code_information":[{"code":"4800093","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93283","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93284 EVAL PROG DEVICE W/PHY ANALYSIS MULTI LEAD ICD","code_information":[{"code":"4800094","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93284","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":225.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93285 PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON","code_information":[{"code":"4800095","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93285","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93286 PERI-PROC DEV EVAL/ANYL S,D,MULT,LDLSS PACER","code_information":[{"code":"4800096","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93286","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93287 PERI-PROC DEV EVAL/ANYL SGL,DUL,MULT ICD","code_information":[{"code":"4800097","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93287","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93288 EVAL SGL,DUAL,MULT,LDLSS PACMKR IN PERSON","code_information":[{"code":"4800098","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93289 EVAL SGL,DUL,MLTY LEAD CARDIO-DFIB  IN PR","code_information":[{"code":"4800099","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93290 INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON","code_information":[{"code":"4800100","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93290","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93291 INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON","code_information":[{"code":"4800101","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93291","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC S,D,M LEAD WEARABLE CARDI-DFIB EVL IN PR","code_information":[{"code":"4800102","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93292","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93293 TRANSTELEPHONIC PACMAKER EVAL EA 90 DAYS","code_information":[{"code":"4800103","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93293","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE TRANSTHOR CONG ANOM COMPLETE","code_information":[{"code":"4800106","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":3265.0,"discounted_cash":1959.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE TRANSTHOR CONG ANOM LIMIT","code_information":[{"code":"4800107","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":1939.0,"discounted_cash":1163.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D COMPLETE W/DOPPLER & COLOR FLOW","code_information":[{"code":"4800108","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":4433.0,"discounted_cash":2659.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE TRANSTHOR 2D COMPLETE","code_information":[{"code":"4800109","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2550.0,"discounted_cash":1530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93308 ECHO TTE TRANSTHOR 2D F/U OR LIMIT-FAC","code_information":[{"code":"4800110","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1803.0,"discounted_cash":1081.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE TRANSESOPH PROBE/IMAG/RPT","code_information":[{"code":"4800111","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":4726.0,"discounted_cash":2835.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE TRANSESOPH CONG ANOM","code_information":[{"code":"4800113","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93315","type":"HCPCS"}],"standard_charges":[{"gross_charge":6059.0,"discounted_cash":3635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO CATH TRANSESOPH (TEE) CONG ANOM-IMAG","code_information":[{"code":"4800114","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93317","type":"HCPCS"}],"standard_charges":[{"gross_charge":4726.0,"discounted_cash":2835.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE MONITORING CONT ASSESS W/O CONTRAST","code_information":[{"code":"4800115","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93318","type":"HCPCS"}],"standard_charges":[{"gross_charge":4726.0,"discounted_cash":2835.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO DOPPLER, COMPLETE","code_information":[{"code":"4800116","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1141.0,"discounted_cash":684.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO DOPPLER, LIMITED OR F/U","code_information":[{"code":"4800117","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":742.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO DOPPLER, COLOR FLOW MAP","code_information":[{"code":"4800118","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TRANSTHORACIC CARDIO REST/STRESS TST","code_information":[{"code":"4800119","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.0,"discounted_cash":1853.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D W/STRESS TEST,W/CONT MONITORING","code_information":[{"code":"4800120","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":4921.0,"discounted_cash":2952.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE USE CONTRAST DURING STRESS ECHO","code_information":[{"code":"4800121","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93352","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93600 BUNDLE OF HIS RECORD","code_information":[{"code":"4800124","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93600","type":"HCPCS"}],"standard_charges":[{"gross_charge":7968.0,"discounted_cash":4780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93602 INTRA-ATRIAL RECORDING","code_information":[{"code":"4800125","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93602","type":"HCPCS"}],"standard_charges":[{"gross_charge":7968.0,"discounted_cash":4780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93603 RIGHT VENTRICULAR RECORDING","code_information":[{"code":"4800126","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93603","type":"HCPCS"}],"standard_charges":[{"gross_charge":2728.0,"discounted_cash":1636.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93609 VENTRICULAR AND/OR INTRA-ATR MAP","code_information":[{"code":"4800127","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93609","type":"HCPCS"}],"standard_charges":[{"gross_charge":4378.0,"discounted_cash":2626.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93610 INTRA-ATRIAL PACING","code_information":[{"code":"4800128","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93610","type":"HCPCS"}],"standard_charges":[{"gross_charge":7968.0,"discounted_cash":4780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93612 INTRAVENTRICULAR PACING","code_information":[{"code":"4800129","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93612","type":"HCPCS"}],"standard_charges":[{"gross_charge":7968.0,"discounted_cash":4780.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93613 INTRACARDIAC EP 3-D MAPPING","code_information":[{"code":"4800130","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93613","type":"HCPCS"}],"standard_charges":[{"gross_charge":9493.0,"discounted_cash":5695.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93615 ESOPH REC ATRIAL ELECT W/W/O VENTR","code_information":[{"code":"4800131","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93615","type":"HCPCS"}],"standard_charges":[{"gross_charge":4378.0,"discounted_cash":2626.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93616 ESOPH REC ATRIAL ELECT W/W/O VENTR, W/ PAC","code_information":[{"code":"4800132","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93616","type":"HCPCS"}],"standard_charges":[{"gross_charge":1870.0,"discounted_cash":1122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93618 INDUCTION OF ARRHYTHMIA BY ELEC PACING","code_information":[{"code":"4800133","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3071.0,"discounted_cash":1842.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93619 COMPREHENSIVE EP EVALUATION","code_information":[{"code":"4800134","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93619","type":"HCPCS"}],"standard_charges":[{"gross_charge":9666.0,"discounted_cash":5799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93620 COMP EP EVAL W/ INDUCT ARRHYTHMIA","code_information":[{"code":"4800135","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93620","type":"HCPCS"}],"standard_charges":[{"gross_charge":9666.0,"discounted_cash":5799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93621 COMP EP EVAL W/ LT ATRIA PACING/RECD","code_information":[{"code":"4800136","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93621","type":"HCPCS"}],"standard_charges":[{"gross_charge":7718.0,"discounted_cash":4630.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93622 EP COMPL  EVAL W/ LT VENT PAC/REC","code_information":[{"code":"4800137","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93622","type":"HCPCS"}],"standard_charges":[{"gross_charge":7859.0,"discounted_cash":4715.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93623 EP PROG STIM AND PACING AFTER IV DRUG","code_information":[{"code":"4800138","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93623","type":"HCPCS"}],"standard_charges":[{"gross_charge":4378.0,"discounted_cash":2626.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EP F/U W/PACING RECORDING (W/ INDUCT)","code_information":[{"code":"4800139","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93624","type":"HCPCS"}],"standard_charges":[{"gross_charge":9666.0,"discounted_cash":5799.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93640 EP EVAL CARD-DEFB LEADS IMPLNT OR REPL","code_information":[{"code":"4800140","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93640","type":"HCPCS"}],"standard_charges":[{"gross_charge":4188.0,"discounted_cash":2512.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93641 EP EVAL CARD-DEFB LEADS TESTING GENER","code_information":[{"code":"4800141","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93641","type":"HCPCS"}],"standard_charges":[{"gross_charge":6262.0,"discounted_cash":3757.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93642 EP EVAL PACING CARDIO-DEFIB","code_information":[{"code":"4800142","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93642","type":"HCPCS"}],"standard_charges":[{"gross_charge":6187.0,"discounted_cash":3712.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EVAL CARDIO FUNCTION TILT TABLE","code_information":[{"code":"4800143","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":3593.0,"discounted_cash":2155.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93662 INTRACARDIAC ECHO DURING INTERVENTION","code_information":[{"code":"4800144","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93662","type":"HCPCS"}],"standard_charges":[{"gross_charge":6635.0,"discounted_cash":3981.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ELECT ANLYSIS ANTITAACH PACEMAKER SYSTEM","code_information":[{"code":"4800145","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93724","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":427.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93799 UNLISTED CARDIOVASCULR SERVICE/PROCEDURE","code_information":[{"code":"4800147","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93799","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.0,"discounted_cash":538.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93797 CARDIAC REHAB W/O ECG MONITOR","code_information":[{"code":"4800148","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93798 CARDIAC REHAB W/CONT ECG MONITOR","code_information":[{"code":"4800150","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.0,"discounted_cash":250.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CARDIAC REHAB ASSESS PHASE I","code_information":[{"code":"4800154","type":"CDM"},{"code":"0943","type":"RC"},{"code":"4800154","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":223.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CARDIAC REHAB CONSULT LEVEL 1","code_information":[{"code":"4800155","type":"CDM"},{"code":"0943","type":"RC"},{"code":"4800155","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93451 RIGHT HEART CATH W O2 SAT & CARD OUTPUT","code_information":[{"code":"4800158","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":10926.0,"discounted_cash":6555.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93452 LEFT HEART CATH W LEFT VENTRICULOGRM INC S & I","code_information":[{"code":"4800159","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93452","type":"HCPCS"}],"standard_charges":[{"gross_charge":16023.0,"discounted_cash":9613.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93453 COMBINED RT/LT HEART CATH INC INJ & S&I","code_information":[{"code":"4800160","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93453","type":"HCPCS"}],"standard_charges":[{"gross_charge":18328.0,"discounted_cash":10996.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93454 CATH PLACE IN CORONARY ARTERY ANGIOGRAPHY","code_information":[{"code":"4800161","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":14490.0,"discounted_cash":8694.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93455 CATH PLACE CORO INC INJ S&I BPASS & LIMA","code_information":[{"code":"4800162","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":17538.0,"discounted_cash":10522.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93457 CATH PLACE CORO INJ S&I BPASS LIMA & RT HRT","code_information":[{"code":"4800163","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93457","type":"HCPCS"}],"standard_charges":[{"gross_charge":24692.0,"discounted_cash":14815.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93458 CATH PLACE CORO INC INJ & S & I, LT HRT","code_information":[{"code":"4800164","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":19712.0,"discounted_cash":11827.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93459 CATH PLACE CORO INJ & S & I BPASS LIMA/LHC","code_information":[{"code":"4800165","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93459","type":"HCPCS"}],"standard_charges":[{"gross_charge":21589.0,"discounted_cash":12953.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93460 CATH PLACE CORO INC INJ/S&I, RT/LT HRT CATH","code_information":[{"code":"4800166","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":21372.0,"discounted_cash":12823.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93461 CATH PLACE CORO INJ S&I BPASS LIMA RT/LT HRT CATH","code_information":[{"code":"4800167","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":24916.0,"discounted_cash":14949.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LEFT HEART CATH BY TRANSSEPTAL PUNCTURE","code_information":[{"code":"4800168","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93462","type":"HCPCS"}],"standard_charges":[{"gross_charge":11587.0,"discounted_cash":6952.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93463 PHARMACOLOGIC AGENT ADMIN","code_information":[{"code":"4800169","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93463","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.0,"discounted_cash":259.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93567 INJ PROC IN CARD CATH  SUPVALV AORTOGRAPHY","code_information":[{"code":"4800171","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93567","type":"HCPCS"}],"standard_charges":[{"gross_charge":3725.0,"discounted_cash":2235.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ PROC IN CARD CATH  PULMONARY ANGIO","code_information":[{"code":"4800172","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93568","type":"HCPCS"}],"standard_charges":[{"gross_charge":3690.0,"discounted_cash":2214.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93456 CATH PLACE CORO INC INJ & S&I W RT HRT","code_information":[{"code":"4800173","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":22681.0,"discounted_cash":13608.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ PROC INC S&I SELECT LV OR LA ANGIO","code_information":[{"code":"4800174","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2970.0,"discounted_cash":1782.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93566 INJ PROC INC S&I SELECT RV OR RA ANGIO","code_information":[{"code":"4800175","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93566","type":"HCPCS"}],"standard_charges":[{"gross_charge":3771.0,"discounted_cash":2262.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO 2D W/STRESS W/MONTIOR W/CONTRAST","code_information":[{"code":"4800178","type":"CDM"},{"code":"0483","type":"RC"},{"code":"C8930","type":"HCPCS"}],"standard_charges":[{"gross_charge":4921.0,"discounted_cash":2952.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE CONG ANOM COMPL W CONTRAST","code_information":[{"code":"4800181","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":3598.0,"discounted_cash":2158.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE CONG ANOM COMPL WO/W CONTRAST","code_information":[{"code":"4800182","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":3920.0,"discounted_cash":2352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE CONG ANOM LIMIT W CONTRAST","code_information":[{"code":"4800183","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.0,"discounted_cash":1281.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE CONG ANOM LIMIT WO/W CONTRAST","code_information":[{"code":"4800184","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2325.0,"discounted_cash":1395.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D COMPLETE W CONTRAST","code_information":[{"code":"4800185","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2803.0,"discounted_cash":1681.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D COMPLETE WO/W CONTRAST","code_information":[{"code":"4800186","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D F/U OR LIMIT-FAC W CONTRAST","code_information":[{"code":"4800187","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2007.0,"discounted_cash":1204.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D F/U OR LIMIT-FAC WO/W CONTRAST","code_information":[{"code":"4800188","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":2187.0,"discounted_cash":1312.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE PROBE/IMAG/RPT W CONTRAST","code_information":[{"code":"4800189","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":5199.0,"discounted_cash":3119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE PROBE/IMAG/RPT WO/W CONTRAST","code_information":[{"code":"4800190","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":5673.0,"discounted_cash":3403.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE CONG ANOM W CONTRAST","code_information":[{"code":"4800191","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93315","type":"HCPCS"}],"standard_charges":[{"gross_charge":6659.0,"discounted_cash":3995.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE CONG ANOM WO/W CONTRAST","code_information":[{"code":"4800192","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93315","type":"HCPCS"}],"standard_charges":[{"gross_charge":7271.0,"discounted_cash":4362.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE MONIT CONT ASSESS W CONTRAST","code_information":[{"code":"4800193","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93318","type":"HCPCS"}],"standard_charges":[{"gross_charge":5199.0,"discounted_cash":3119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TEE MONIT CONT ASSESS WO/W CONTRAST","code_information":[{"code":"4800194","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93318","type":"HCPCS"}],"standard_charges":[{"gross_charge":5673.0,"discounted_cash":3403.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE CARDIO REST/STRESS TST W CONTRAST","code_information":[{"code":"4800195","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":4057.0,"discounted_cash":2434.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE CARDIO REST/STRESS TST WO/W CONTRAST","code_information":[{"code":"4800196","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":4428.0,"discounted_cash":2656.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D COMP W/DOPPLER W CONTRAST","code_information":[{"code":"4800197","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":4875.0,"discounted_cash":2925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D COMP W/DOPPLER WO/W CONTRAST","code_information":[{"code":"4800198","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":5318.0,"discounted_cash":3190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D W/STRESS TST,W/CONT MONIT W OR WO/W CONTRAST","code_information":[{"code":"4800199","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":5415.0,"discounted_cash":3249.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TTE 2D W/STRESS TST,W/CONT MONIT WO/W CONTRAST","code_information":[{"code":"4800200","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":4378.0,"discounted_cash":2626.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92920 PTCA SINGLE MAJOR CORONARY ART-RC","code_information":[{"code":"4800206","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":12425.0,"discounted_cash":7455.0,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92920 PTCA SINGLE MAJOR CORONARY ART-LD","code_information":[{"code":"4800207","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":12425.0,"discounted_cash":7455.0,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92920 PTCA SINGLE MAJOR CORONARY ART-LC","code_information":[{"code":"4800208","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":12425.0,"discounted_cash":7455.0,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92920 PTCA SINGLE MAJOR CORONARY ART-LM","code_information":[{"code":"4800209","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":12425.0,"discounted_cash":7455.0,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92920 PTCA SINGLE MAJOR CORONARY ART-RI","code_information":[{"code":"4800210","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":12425.0,"discounted_cash":7455.0,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92924 PTCA W/ ATHERECT SGL MAJ CORON ART-RC","code_information":[{"code":"4800216","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":30220.0,"discounted_cash":18132.0,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92924 PTCA W/ ATHERECT SGL MAJ CORON ART-LD","code_information":[{"code":"4800217","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":30220.0,"discounted_cash":18132.0,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92924 PTCA W/ ATHERECT SGL MAJ CORON ART-LC","code_information":[{"code":"4800218","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":30220.0,"discounted_cash":18132.0,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92924 PTCA W/ ATHERECT SGL MAJ CORON ART-LM","code_information":[{"code":"4800219","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":30220.0,"discounted_cash":18132.0,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92924 PTCA W/ ATHERECT SGL MAJ CORON ART-RI","code_information":[{"code":"4800220","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92924","type":"HCPCS"}],"standard_charges":[{"gross_charge":30220.0,"discounted_cash":18132.0,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92928 PERC TRANSCATH PLACE BARE METAL STNT(S) SGL ART-RC","code_information":[{"code":"4800226","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92928 PERC TRANSCATH PLACE BARE METL STNT(S) SGL ART-LD","code_information":[{"code":"4800227","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92928 PERC TRANSCATH PLACE BARE METL STNT(S) SGL ART-LC","code_information":[{"code":"4800228","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92928 PERC TRANSCATH PLACE BARE METL STNT(S) SGL ART-LM","code_information":[{"code":"4800229","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92928 PERC TRANSCATH PLACE BARE METL STNT(S) SGL ART-RI","code_information":[{"code":"4800230","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92928/C9600 PERC TRANSCATH PLACE DRUG ELUT STNT(S) SGL ART-RC","code_information":[{"code":"4800231","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92928/C9600  PERC TRANSCATH PLACE DRUG ELUT STNT(S) SGL ART-LD","code_information":[{"code":"4800232","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92928/C9600  PERC TRANSCATH PLACE DRUG ELUT STNT(S) SGL ART-LC","code_information":[{"code":"4800233","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92928/C9600 PERC TRANSCATH PLACE DRUG ELUT STNT(S) SGL ART-LM","code_information":[{"code":"4800234","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92928/C9600 PERC TRANSCATH PLACE DRUG ELUT STENT(S) SGL ART-RI","code_information":[{"code":"4800235","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92933 PERC TRANSLUM ATHERECT W/BARE METL STNT SGL MAJ ART-RC","code_information":[{"code":"4800246","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92933 PERC TRANSLUM ATHERECT W/BARE METL STNT SGL MAJ ART-LD","code_information":[{"code":"4800247","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92933 PERC TRANSLUM ATHERECT W/BARE METL STNT SGL MAJ ART-LC","code_information":[{"code":"4800248","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92933 PERC TRANSLUM ATHERECT W/BARE METL STNT SGL MAJ ART-LM","code_information":[{"code":"4800249","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92933 PERC TRANSLUM ATHERECT W/BARE METL STNT SGL MAJ ART-RI","code_information":[{"code":"4800250","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92933/C9602 PERC TRANSLUM ATHERECT W/DRUG ELUT STNT SGL MAJ ART-RC","code_information":[{"code":"4800251","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92933/C9602 PERC TRANSLUM ATHERECT W/DRUG ELUT STNT SGL MAJ ART-LD","code_information":[{"code":"4800252","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92933/C9602 PERC TRANSLUM ATHERECT W/DRUG ELUT STNT SGL MAJ ART-LC","code_information":[{"code":"4800253","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92933/C9602 PERC TRANSLUM ATHERECT W/DRUG ELUT STNT SGL MAJ ART-LM","code_information":[{"code":"4800254","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92933/C9602 PERC TRANSLUM ATHERECT W/DRUG ELUT STNT SGL MAJ ART-RI","code_information":[{"code":"4800255","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92933","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/BARE METL STNT-RC","code_information":[{"code":"4800266","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/BARE METL STNT-LD","code_information":[{"code":"4800267","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/BARE METL STNT-LC","code_information":[{"code":"4800268","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/BARE METL STNT-LM","code_information":[{"code":"4800269","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/BARE METL STNT-RI","code_information":[{"code":"4800270","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92937/C9604 PERC TRANSLUM REVASC CABG SGL VESS W/DRG ELUT STNT-RC","code_information":[{"code":"4800271","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92937/C9604 PERC TRANSLUM REVASC CABG SGL VESS W/DRG ELUT STNT-LD","code_information":[{"code":"4800272","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92937/C9604 PERC TRANSLUM REVASC CABG SGL VESS W/DRG ELUT STNT-LC","code_information":[{"code":"4800273","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92937/C9604 PERC TRANSLUM REVASC CABG SGL VESS W/DRG ELUT STNT-LM","code_information":[{"code":"4800274","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC  92937/C9604 PERC TRANSLUM REVASC CABG SGL VESS W/DRG ELUT STNT-RI","code_information":[{"code":"4800275","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/BARE METL STNT-RC","code_information":[{"code":"4800286","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":52445.0,"discounted_cash":31467.0,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/BARE METL STNT-LD","code_information":[{"code":"4800287","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":52445.0,"discounted_cash":31467.0,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/BARE METL STNT-LC","code_information":[{"code":"4800288","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":52445.0,"discounted_cash":31467.0,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/BARE METL STNT-LM","code_information":[{"code":"4800289","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":52445.0,"discounted_cash":31467.0,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/BARE METL STNT-RI","code_information":[{"code":"4800290","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":52445.0,"discounted_cash":31467.0,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92941/C9606 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/DRG ELUT STNT-RC","code_information":[{"code":"4800291","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":56207.0,"discounted_cash":33724.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92941/C9606 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/DRG ELUT STNT-LD","code_information":[{"code":"4800292","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":56207.0,"discounted_cash":33724.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92941/C9606 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/DRG ELUT STNT-LC","code_information":[{"code":"4800293","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":56207.0,"discounted_cash":33724.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92941/C9606 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/DRG ELUT STNT-LM","code_information":[{"code":"4800294","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":56207.0,"discounted_cash":33724.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92941/C9606 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/DRG ELUT STNT-RI","code_information":[{"code":"4800295","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":56207.0,"discounted_cash":33724.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/BARE METL STNT-RC","code_information":[{"code":"4800296","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/BARE METL STNT-LD","code_information":[{"code":"4800297","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/BARE METL STNT-LC","code_information":[{"code":"4800298","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/BARE METL STNT-LM","code_information":[{"code":"4800299","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/BARE METL STNT-RI","code_information":[{"code":"4800300","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92943/C9607 PERC TRANSLUM REVASC CHRON OCCL SGL W/DRG ELUT STNT-RC","code_information":[{"code":"4800301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92943/C9607 PERC TRANSLUM REVASC CHRON OCCL SGL W/DRG ELUT STNT-LD","code_information":[{"code":"4800302","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92943/C9607 PERC TRANSLUM REVASC CHRON OCCL SGL W/DRG ELUT STNT-LC","code_information":[{"code":"4800303","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92943/C9607 PERC TRANSLUM REVASC CHRON OCCL SGL W/DRG ELUT STNT-LM","code_information":[{"code":"4800304","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92943/C9607 PERC TRANSLUM REVASC CHRON OCCL SGL W/DRG ELUT STNT-RI","code_information":[{"code":"4800305","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":48323.0,"discounted_cash":28993.8,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 93653 COMP EP EVAL INS/REPOS ELECTRODE CATHS SGL ATRIAL FOCUS","code_information":[{"code":"4800316","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93653","type":"HCPCS"}],"standard_charges":[{"gross_charge":25759.0,"discounted_cash":15455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93654 COMP EP EVAL INS/REPOS ELECTRODE CATHS VENT ECTOPY FOCUS","code_information":[{"code":"4800317","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93654","type":"HCPCS"}],"standard_charges":[{"gross_charge":25759.0,"discounted_cash":15455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93655 INTRACARDIAC CATH ABLAT MECH OF ARRHYTHMIA","code_information":[{"code":"4800318","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93655","type":"HCPCS"}],"standard_charges":[{"gross_charge":20492.0,"discounted_cash":12295.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93656 COMP EP EVAL W TRNSEPTAL CATH INS/REPOS MULT ELECTRD CATHS","code_information":[{"code":"4800319","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93656","type":"HCPCS"}],"standard_charges":[{"gross_charge":25759.0,"discounted_cash":15455.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93657 ADD LINEAR OR FOCAL INTRACARDIAC CATH ABLATION FOR A-FIB","code_information":[{"code":"4800320","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93657","type":"HCPCS"}],"standard_charges":[{"gross_charge":20492.0,"discounted_cash":12295.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36221 NON-SLCT CATH PLACE THOR AORTA W/ANGIO CC ARCH","code_information":[{"code":"4800321","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36221","type":"HCPCS"}],"standard_charges":[{"gross_charge":11008.0,"discounted_cash":6604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SLCT CATH PLACE COMM CARTD ART W/ANGIO CC ARCH-RT","code_information":[{"code":"4800322","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":11967.0,"discounted_cash":7180.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLACE COMM CARTD ART W/ANGIO CC ARCH-LT","code_information":[{"code":"4800323","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":11967.0,"discounted_cash":7180.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLACE COMM CARTD ART W/ANGIO CC ARCH-BLT","code_information":[{"code":"4800324","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":17949.0,"discounted_cash":10769.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36223 SLCT CATH PLACE COMM CARTD ART W/ANGIO EC CARTD-RT","code_information":[{"code":"4800325","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":17954.0,"discounted_cash":10772.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36223 SLCT CATH PLACE COMM CARTD ART W/ANGIO EC CARTD-LT","code_information":[{"code":"4800326","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":17954.0,"discounted_cash":10772.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36223 SLCT CATH PLACE COMM CARTD ART W/ANGIO EC CARTD-BLT","code_information":[{"code":"4800327","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36223","type":"HCPCS"}],"standard_charges":[{"gross_charge":26930.0,"discounted_cash":16158.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC SLCT CATH PLACE INTNL CARTD ART W/ANGIO EC CARTD-RT","code_information":[{"code":"4800328","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":29359.0,"discounted_cash":17615.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLACE INTNL CARTD ART W/ANGIO EC CARTD-LT","code_information":[{"code":"4800329","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":29359.0,"discounted_cash":17615.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLACE INTNL CARTD ART W/ANGIO EC CARTD-BLT","code_information":[{"code":"4800330","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36224","type":"HCPCS"}],"standard_charges":[{"gross_charge":44037.0,"discounted_cash":26422.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36225 SLCT CATH PLACE SUBCLV ART W/ANGIO CC ARCH-RT","code_information":[{"code":"4800331","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":17954.0,"discounted_cash":10772.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36225 SLCT CATH PLACE SUBCLV ART W/ANGIO CC ARCH-LT","code_information":[{"code":"4800332","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":17954.0,"discounted_cash":10772.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36225 SLCT CATH PLACE SUBCLV ART W/ANGIO CC ARCH-BLT","code_information":[{"code":"4800333","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36225","type":"HCPCS"}],"standard_charges":[{"gross_charge":26930.0,"discounted_cash":16158.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 36226 SLCT CATH PLACE VERT ART W/ANGIO CC ARCH-RT","code_information":[{"code":"4800334","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":29359.0,"discounted_cash":17615.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36226 SLCT CATH PLACE VERT ART W/ANGIO CC ARCH-LT","code_information":[{"code":"4800335","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":29359.0,"discounted_cash":17615.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 36226 SLCT CATH PLACE VERT ART W/ANGIO CC ARCH-BLT","code_information":[{"code":"4800336","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":44037.0,"discounted_cash":26422.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC SLCT CATH PLACE EA INTRACRANL BRANCH INTL CAROTD/VERT ART-RT","code_information":[{"code":"4800337","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":13374.0,"discounted_cash":8024.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLACE EA INTRACRANL BRANCH INTL CAROTD/VERT ART-LT","code_information":[{"code":"4800338","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":13374.0,"discounted_cash":8024.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLACE EA INTRACRANL BRANCH INTL CAROTD/VERT ART-BLT","code_information":[{"code":"4800339","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36228","type":"HCPCS"}],"standard_charges":[{"gross_charge":20071.0,"discounted_cash":12042.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC SLCT CATH PLC EXT CARTD ART W/ANGIO IPSILAT EX CARTD-RT","code_information":[{"code":"4800340","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":10704.0,"discounted_cash":6422.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLC EXT CARTD ART W/ANGIO IPSILAT EX CARTD-LT","code_information":[{"code":"4800341","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":10704.0,"discounted_cash":6422.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SLCT CATH PLC EXT CARTD ART W/ANGIO IPSILAT EX CARTD-BLT","code_information":[{"code":"4800342","type":"CDM"},{"code":"0481","type":"RC"},{"code":"36227","type":"HCPCS"}],"standard_charges":[{"gross_charge":16050.0,"discounted_cash":9630.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/O STNT-RC","code_information":[{"code":"4800343","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/O STNT-LD","code_information":[{"code":"4800344","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/O STNT-LC","code_information":[{"code":"4800345","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/O STNT-LM","code_information":[{"code":"4800346","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/O STNT-RI","code_information":[{"code":"4800347","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/O STNT-RC","code_information":[{"code":"4800353","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":27468.0,"discounted_cash":16480.8,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/O STNT-LD","code_information":[{"code":"4800354","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":27468.0,"discounted_cash":16480.8,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/O STNT-LC","code_information":[{"code":"4800355","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":27468.0,"discounted_cash":16480.8,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/O STNT-LM","code_information":[{"code":"4800356","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":27468.0,"discounted_cash":16480.8,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92941 PERC TRANSLUM REVASC ACUT OCCL IN MI SGL W/O STNT-RI","code_information":[{"code":"4800357","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":27468.0,"discounted_cash":16480.8,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/O STNT-RC","code_information":[{"code":"4800358","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":29437.0,"discounted_cash":17662.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/O STNT-LD","code_information":[{"code":"4800359","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":29437.0,"discounted_cash":17662.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/O STNT-LC","code_information":[{"code":"4800360","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":29437.0,"discounted_cash":17662.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/O STNT-LM","code_information":[{"code":"4800361","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":29437.0,"discounted_cash":17662.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92943 PERC TRANSLUM REVASC CHRON OCCL SGL W/O STNT-RI","code_information":[{"code":"4800362","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":29437.0,"discounted_cash":17662.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC PROGRAMMING DEVICE EVAL; IMPLANT SUBQ LEAD DEFIB SYSTEM","code_information":[{"code":"4800372","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93260","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INTERROGATION DEVICE EVAL; IMPLANT SUBQ LEAD DEFIB SYSTEM","code_information":[{"code":"4800373","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93261","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECHO TRANSESOPHAGEAL (TEE) FOR GUIDE TCATH INTRACARDIAL/VESSEL STRUCT INTRVTN","code_information":[{"code":"4800374","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93355","type":"HCPCS"}],"standard_charges":[{"gross_charge":4710.0,"discounted_cash":2826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93644 ELECTROPHYSIOLOGIC EVAL SUBQ IMPLANTABLE DEFIBRILLATOR","code_information":[{"code":"4800375","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93644","type":"HCPCS"}],"standard_charges":[{"gross_charge":6262.0,"discounted_cash":3757.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92978 ENDOLUMINAL IVUS/OCT CORON, INITIAL VESSEL","code_information":[{"code":"4800386","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":1562.0,"discounted_cash":937.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92979 ENDOLUMINAL IVUS/OCT CORON, EACH ADD VESSEL","code_information":[{"code":"4800387","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93668 PERIPHERAL ARTERIAL DIS REHAB P/SESS 45-60 MIN","code_information":[{"code":"4800401","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93668","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33274 INSRT/RPL PERM LEADLESS PACEMAKER R VENTR W/IMG W/ DEVICE EVAL","code_information":[{"code":"4800402","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33274","type":"HCPCS"}],"standard_charges":[{"gross_charge":32048.0,"discounted_cash":19228.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33275 REMOVAL PERM LEADLESS PACEMAKER R VENTR","code_information":[{"code":"4800403","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33275","type":"HCPCS"}],"standard_charges":[{"gross_charge":34388.0,"discounted_cash":20632.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33285  INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG","code_information":[{"code":"4800404","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":15472.0,"discounted_cash":9283.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33286 REMOVAL SUBQ CARDIAC RHYTHM MONITOR","code_information":[{"code":"4800405","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":3107.0,"discounted_cash":1864.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33289 TCATH IMPLNT WIRELSS PULM-ARTERY PRSS SNSR L-T HEMODYN MNTR","code_information":[{"code":"4800406","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33289","type":"HCPCS"}],"standard_charges":[{"gross_charge":34897.0,"discounted_cash":20938.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93356 MYOCARDIAL STRAIN IMAGING SPECKLE TRCK ASSMT MYOCRD MECH","code_information":[{"code":"4800430","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92920 PTCA SINGLE MAJOR CORONARY ART","code_information":[{"code":"4800431","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":12425.0,"discounted_cash":7455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92928 PERC TRANSCATH PLACE DRUG ELUT STNT(S) SGL ART","code_information":[{"code":"4800433","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92928","type":"HCPCS"}],"standard_charges":[{"gross_charge":30524.0,"discounted_cash":18314.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92937 PERC TRANSLUM REVASC CABG SGL VESS W/DRG ELUT STNT","code_information":[{"code":"4800435","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9764 REVASC INTRAVASC LITHOTRIPSY","code_information":[{"code":"4800440","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":29149.0,"discounted_cash":17489.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9765 REVASC INTRA LITHOTRIP-STENT","code_information":[{"code":"4800441","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":46607.0,"discounted_cash":27964.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9766 REVASC INTRA LITHOTRIP-ATHER","code_information":[{"code":"4800442","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9766","type":"HCPCS"}],"standard_charges":[{"gross_charge":46607.0,"discounted_cash":27964.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9767 REVASC LITHOTRIP-STENT-ATHER","code_information":[{"code":"4800443","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9767","type":"HCPCS"}],"standard_charges":[{"gross_charge":46607.0,"discounted_cash":27964.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33741 TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD","code_information":[{"code":"4800444","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33741","type":"HCPCS"}],"standard_charges":[{"gross_charge":11650.0,"discounted_cash":6990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0408T INSJ/RPLC CAR MODULJ SYS PLS GEN TRANSVNS ELTRD","code_information":[{"code":"4800447","type":"CDM"},{"code":"0481","type":"RC"},{"code":"0408T","type":"HCPCS"}],"standard_charges":[{"gross_charge":55153.0,"discounted_cash":33091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0544T TRANSCATH MITRAL VALVE ANNULUS RECONST W/IMPL ADJ ANNULUS RECON DEV PERCUT","code_information":[{"code":"4800448","type":"CDM"},{"code":"0481","type":"RC"},{"code":"0544T","type":"HCPCS"}],"standard_charges":[{"gross_charge":19630.0,"discounted_cash":11778.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93593 R HRT CATH CONGEN DEFECT NML NT CNJ","code_information":[{"code":"4800449","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93593","type":"HCPCS"}],"standard_charges":[{"gross_charge":14903.0,"discounted_cash":8941.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93594 R HRT CATH CONGEN DEFECT ABNL NT CNJ","code_information":[{"code":"4800450","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93594","type":"HCPCS"}],"standard_charges":[{"gross_charge":14903.0,"discounted_cash":8941.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93595 L HRT CATH CONGEN DEFECT NML/ABNL NT CNJ","code_information":[{"code":"4800451","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93595","type":"HCPCS"}],"standard_charges":[{"gross_charge":14903.0,"discounted_cash":8941.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93596 R&L HRT CATH CONGEN DEFECT NML NT CNJ","code_information":[{"code":"4800452","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93596","type":"HCPCS"}],"standard_charges":[{"gross_charge":14903.0,"discounted_cash":8941.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93597 R&L HRT CATH CONGEN DEFECT ABNL NT CNJ","code_information":[{"code":"4800453","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93597","type":"HCPCS"}],"standard_charges":[{"gross_charge":14903.0,"discounted_cash":8941.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93598 CARD OUTPUT MEAS DRNG CARD CATH EVAL HRT DEFECT","code_information":[{"code":"4800454","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93598","type":"HCPCS"}],"standard_charges":[{"gross_charge":2596.0,"discounted_cash":1557.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33894 EVASC ST RPR THRC/AA ACRS BR","code_information":[{"code":"4800455","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33894","type":"HCPCS"}],"standard_charges":[{"gross_charge":62821.0,"discounted_cash":37692.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33895 EVASC ST RPR THRC/AA X CRSG","code_information":[{"code":"4800456","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33895","type":"HCPCS"}],"standard_charges":[{"gross_charge":53397.0,"discounted_cash":32038.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33897 PERQ TRLUML ANGP NT/RECR COA","code_information":[{"code":"4800457","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33897","type":"HCPCS"}],"standard_charges":[{"gross_charge":45389.0,"discounted_cash":27233.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93319 3D ECHO IMG CGEN CAR ANOMAL","code_information":[{"code":"4800458","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93319","type":"HCPCS"}],"standard_charges":[{"gross_charge":1760.0,"discounted_cash":1056.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9772 REVASCULARIZATION, TIBIAL/PERONEAL ARTERY(IES),  WITH INTRA LITHOTRIP","code_information":[{"code":"4800459","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"gross_charge":29149.0,"discounted_cash":17489.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9773 REVASCULARIZATION, TIBIAL/PERONEAL; WITH IVL, & TRANSLUMINAL STENT","code_information":[{"code":"4800460","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9773","type":"HCPCS"}],"standard_charges":[{"gross_charge":46607.0,"discounted_cash":27964.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9774 REVASCULARIZATION, TIBIAL/PERONEAL; WITH IVL & ATHERECTOMY","code_information":[{"code":"4800461","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9774","type":"HCPCS"}],"standard_charges":[{"gross_charge":46607.0,"discounted_cash":27964.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C9775 REVASCULARIZATION, TIBIAL/PERONEAL; W IVL & TRANS STENT & ATHERECTOMY","code_information":[{"code":"4800462","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9775","type":"HCPCS"}],"standard_charges":[{"gross_charge":46607.0,"discounted_cash":27964.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92972 PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY","code_information":[{"code":"4800467","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92972","type":"HCPCS"}],"standard_charges":[{"gross_charge":8237.0,"discounted_cash":4942.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 75580 NONINVASIVE ESTIMATE OF CORONARY FFR FRACTIONAL FLOW RESERVE","code_information":[{"code":"4800468","type":"CDM"},{"code":"0350","type":"RC"},{"code":"75580","type":"HCPCS"}],"standard_charges":[{"gross_charge":3209.0,"discounted_cash":1925.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0913T PERC TRANSCATH RX DLVR INTRA-C RX BLN 1 MAJ C-ART W IMG SUP & RPT","code_information":[{"code":"4800473","type":"CDM"},{"code":"0480","type":"RC"},{"code":"0913T","type":"HCPCS"}],"standard_charges":[{"gross_charge":12550.0,"discounted_cash":7530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 0914T PERC TRANSCATH RX DLVR INTRA-C RX BLN SEP TRGT C STNT PLCMT, C ATHRCTMY","code_information":[{"code":"4800474","type":"CDM"},{"code":"0480","type":"RC"},{"code":"0914T","type":"HCPCS"}],"standard_charges":[{"gross_charge":6275.0,"discounted_cash":3765.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 37254 REVASC EVASC IVT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800492","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37254","type":"HCPCS"}],"standard_charges":[{"gross_charge":17445.0,"discounted_cash":10467.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37254 REVASC EVASC IVT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800493","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37254","type":"HCPCS"}],"standard_charges":[{"gross_charge":17445.0,"discounted_cash":10467.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37254 REVASC EVASC IVT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800494","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37254","type":"HCPCS"}],"standard_charges":[{"gross_charge":26168.0,"discounted_cash":15700.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37255 REVASC EVASC IVT ANGIOP UNI STRAIGHTFRWRD LESION, EA ADD-LT","code_information":[{"code":"4800495","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37255","type":"HCPCS"}],"standard_charges":[{"gross_charge":10467.0,"discounted_cash":6280.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37255 REVASC EVASC IVT ANGIOP UNI STRAIGHTFRWRD LESION, EA ADD-RT","code_information":[{"code":"4800496","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37255","type":"HCPCS"}],"standard_charges":[{"gross_charge":10467.0,"discounted_cash":6280.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37256 REVASC EVASC IVT ANGIOP UNI COMPLEX LESION, INITL-LT","code_information":[{"code":"4800497","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37256","type":"HCPCS"}],"standard_charges":[{"gross_charge":25690.0,"discounted_cash":15414.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37256 REVASC EVASC IVT ANGIOP UNI COMPLEX LESION, INITL-RT","code_information":[{"code":"4800498","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37256","type":"HCPCS"}],"standard_charges":[{"gross_charge":25690.0,"discounted_cash":15414.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37256 REVASC EVASC IVT ANGIOP UNI COMPLEX LESION, INITL-BLT","code_information":[{"code":"4800499","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37256","type":"HCPCS"}],"standard_charges":[{"gross_charge":38535.0,"discounted_cash":23121.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37257 REVASC EVASC IVT ANGIOP UNI COMPLEX LESION, EA ADD-LT","code_information":[{"code":"4800500","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37257","type":"HCPCS"}],"standard_charges":[{"gross_charge":15414.0,"discounted_cash":9248.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37257 REVASC EVASC IVT ANGIOP UNI COMPLEX LESION, EA ADD-RT","code_information":[{"code":"4800501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37257","type":"HCPCS"}],"standard_charges":[{"gross_charge":15414.0,"discounted_cash":9248.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37258 REVASC EVASC IVT STENT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800502","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37258","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37258 REVASC EVASC IVT STENT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800503","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37258","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37258 REVASC EVASC IVT STENT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800504","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37258","type":"HCPCS"}],"standard_charges":[{"gross_charge":53073.0,"discounted_cash":31843.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37260 REVASC EVASC IVT STENT ANGIOP UNI COMPLEX LESION, INITL-LT","code_information":[{"code":"4800507","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37260","type":"HCPCS"}],"standard_charges":[{"gross_charge":51314.0,"discounted_cash":30788.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37260 REVASC EVASC IVT STENT ANGIOP UNI COMPLEX LESION, INITL-RT","code_information":[{"code":"4800508","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37260","type":"HCPCS"}],"standard_charges":[{"gross_charge":51314.0,"discounted_cash":30788.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37260 REVASC EVASC IVT STENT ANGIOP UNI COMPLEX LESION, INITL-BLT","code_information":[{"code":"4800509","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37260","type":"HCPCS"}],"standard_charges":[{"gross_charge":76971.0,"discounted_cash":46182.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37262 INTRAVASCULAR LITHOTRIPSY IVT WITHIN SAME ARTERY-LT","code_information":[{"code":"4800512","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37262","type":"HCPCS"}],"standard_charges":[{"gross_charge":14985.0,"discounted_cash":8991.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37262 INTRAVASCULAR LITHOTRIPSY IVT WITHIN SAME ARTERY-RT","code_information":[{"code":"4800513","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37262","type":"HCPCS"}],"standard_charges":[{"gross_charge":14985.0,"discounted_cash":8991.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37263 REVASC EVASC FPVT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800514","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37263","type":"HCPCS"}],"standard_charges":[{"gross_charge":17445.0,"discounted_cash":10467.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37263 REVASC EVASC FPVT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800515","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37263","type":"HCPCS"}],"standard_charges":[{"gross_charge":17445.0,"discounted_cash":10467.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37263 REVASC EVASC FPVT ANGIOP UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800516","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37263","type":"HCPCS"}],"standard_charges":[{"gross_charge":26168.0,"discounted_cash":15700.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37264 REVASC EVASC FPVT ANGIOP UNI STRAIGHTFRWRD LESION, EA ADD-LT","code_information":[{"code":"4800517","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37264","type":"HCPCS"}],"standard_charges":[{"gross_charge":10467.0,"discounted_cash":6280.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37264 REVASC EVASC FPVT ANGIOP UNI STRAIGHTFRWRD LESION, EA ADD-RT","code_information":[{"code":"4800518","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37264","type":"HCPCS"}],"standard_charges":[{"gross_charge":10467.0,"discounted_cash":6280.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37265 REVASC EVASC FPVT ANGIOP UNI COMPLEX LESION, INITL-LT","code_information":[{"code":"4800519","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37265","type":"HCPCS"}],"standard_charges":[{"gross_charge":23635.0,"discounted_cash":14181.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37265 REVASC EVASC FPVT ANGIOP UNI COMPLEX LESION, INITL-RT","code_information":[{"code":"4800520","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37265","type":"HCPCS"}],"standard_charges":[{"gross_charge":23635.0,"discounted_cash":14181.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37265 REVASC EVASC FPVT ANGIOP UNI COMPLEX LESION, INITL-BLT","code_information":[{"code":"4800521","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37265","type":"HCPCS"}],"standard_charges":[{"gross_charge":35453.0,"discounted_cash":21271.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37266 REVASC EVASC FPVT ANGIOP UNI COMPLEX LESION, EA ADD-LT","code_information":[{"code":"4800522","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37266","type":"HCPCS"}],"standard_charges":[{"gross_charge":14181.0,"discounted_cash":8508.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37266 REVASC EVASC FPVT ANGIOP UNI COMPLEX LESION, EA ADD-RT","code_information":[{"code":"4800523","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37266","type":"HCPCS"}],"standard_charges":[{"gross_charge":14181.0,"discounted_cash":8508.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37267 REVASC EVASC FPVT STENT ANGIO UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800524","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37267","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37267 REVASC EVASC FPVT STENT ANGIO UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800525","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37267","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37267 REVASC EVASC FPVT STENT ANGIO UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800526","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37267","type":"HCPCS"}],"standard_charges":[{"gross_charge":53073.0,"discounted_cash":31843.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37268 REVASC EVASC FPVT STENT ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-LT","code_information":[{"code":"4800527","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37268","type":"HCPCS"}],"standard_charges":[{"gross_charge":21229.0,"discounted_cash":12737.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37268 REVASC EVASC FPVT STENT ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-RT","code_information":[{"code":"4800528","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37268","type":"HCPCS"}],"standard_charges":[{"gross_charge":21229.0,"discounted_cash":12737.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37269 REVASC EVASC FPVT STENT ANGIO UNI COMPLEX LESION, INITL-LT","code_information":[{"code":"4800529","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37269","type":"HCPCS"}],"standard_charges":[{"gross_charge":59644.0,"discounted_cash":35786.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37269 REVASC EVASC FPVT STENT ANGIO UNI COMPLEX LESION, INITL-RT","code_information":[{"code":"4800530","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37269","type":"HCPCS"}],"standard_charges":[{"gross_charge":59644.0,"discounted_cash":35786.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37269 REVASC EVASC FPVT STENT ANGIO UNI COMPLEX LESION, INITL-BLT","code_information":[{"code":"4800531","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37269","type":"HCPCS"}],"standard_charges":[{"gross_charge":89466.0,"discounted_cash":53679.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37270 REVASC EVASC FPVT STENT ANGIO UNI COMPLEX, EA ADD-LT","code_information":[{"code":"4800532","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37270","type":"HCPCS"}],"standard_charges":[{"gross_charge":35786.0,"discounted_cash":21471.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37270 REVASC EVASC FPVT STENT ANGIO UNI COMPLEX, EA ADD-RT","code_information":[{"code":"4800533","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37270","type":"HCPCS"}],"standard_charges":[{"gross_charge":35786.0,"discounted_cash":21471.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37271 REVASC EVASC FPVT ATHRC ANGIO UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800534","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37271","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37271 REVASC EVASC FPVT ATHRC ANGIO UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800535","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37271","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37271 REVASC EVASC FPVT ATHRC ANGIO UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800536","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37271","type":"HCPCS"}],"standard_charges":[{"gross_charge":84281.0,"discounted_cash":50568.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37272 REVASC EVASC FPVT ATHRC ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-LT","code_information":[{"code":"4800537","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37272","type":"HCPCS"}],"standard_charges":[{"gross_charge":33712.0,"discounted_cash":20227.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37272 REVASC EVASC FPVT ATHRC ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-RT","code_information":[{"code":"4800538","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37272","type":"HCPCS"}],"standard_charges":[{"gross_charge":33712.0,"discounted_cash":20227.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37273 REVASC EVASC FPVT ATHRC ANGIO UNI COMPLEX, INITL-LT","code_information":[{"code":"4800539","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37273","type":"HCPCS"}],"standard_charges":[{"gross_charge":78849.0,"discounted_cash":47309.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37273 REVASC EVASC FPVT ATHRC ANGIO UNI COMPLEX, INITL-RT","code_information":[{"code":"4800540","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37273","type":"HCPCS"}],"standard_charges":[{"gross_charge":78849.0,"discounted_cash":47309.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37273 REVASC EVASC FPVT ATHRC ANGIO UNI COMPLEX, INITL-BLT","code_information":[{"code":"4800541","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37273","type":"HCPCS"}],"standard_charges":[{"gross_charge":118274.0,"discounted_cash":70964.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37274 REVASC EVASC FPVT ATHRC ANGIO UNI COMPLEX, EA ADD-LT","code_information":[{"code":"4800542","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37274","type":"HCPCS"}],"standard_charges":[{"gross_charge":47309.0,"discounted_cash":28385.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37274 REVASC EVASC FPVT ATHRC ANGIO UNI COMPLEX, EA ADD-RT","code_information":[{"code":"4800543","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37274","type":"HCPCS"}],"standard_charges":[{"gross_charge":47309.0,"discounted_cash":28385.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37280 REVASC EVASC TPVT ANGIO UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800556","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37280","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37280 REVASC EVASC TPVT ANGIO UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800557","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37280","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37280 REVASC EVASC TPVT ANGIO UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800558","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37280","type":"HCPCS"}],"standard_charges":[{"gross_charge":53073.0,"discounted_cash":31843.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37281 REVASC EVASC TPVT ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-LT","code_information":[{"code":"4800559","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37281","type":"HCPCS"}],"standard_charges":[{"gross_charge":21229.0,"discounted_cash":12737.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37281 REVASC EVASC TPVT ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-RT","code_information":[{"code":"4800560","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37281","type":"HCPCS"}],"standard_charges":[{"gross_charge":21229.0,"discounted_cash":12737.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37282 REVASC EVASC TPVT ANGIO UNI COMPLEX LESION, INITL-LT","code_information":[{"code":"4800561","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37282","type":"HCPCS"}],"standard_charges":[{"gross_charge":44444.0,"discounted_cash":26666.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37282 REVASC EVASC TPVT ANGIO UNI COMPLEX LESION, INITL-RT","code_information":[{"code":"4800562","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37282","type":"HCPCS"}],"standard_charges":[{"gross_charge":44444.0,"discounted_cash":26666.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37282 REVASC EVASC TPVT ANGIO UNI COMPLEX LESION, INITL-BLT","code_information":[{"code":"4800563","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37282","type":"HCPCS"}],"standard_charges":[{"gross_charge":66666.0,"discounted_cash":39999.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37283 REVASC EVASC TPVT ANGIO UNI COMPLEX LESION, EA ADD-LT","code_information":[{"code":"4800564","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37283","type":"HCPCS"}],"standard_charges":[{"gross_charge":26666.0,"discounted_cash":15999.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37283 REVASC EVASC TPVT ANGIO UNI COMPLEX LESION, EA ADD-RT","code_information":[{"code":"4800565","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37283","type":"HCPCS"}],"standard_charges":[{"gross_charge":26666.0,"discounted_cash":15999.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37288 REVASC EVASC TPVT ATHRC UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800576","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37288","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37288 REVASC EVASC TPVT ATHRC UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800577","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37288","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37288 REVASC EVASC TPVT ATHRC UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800578","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37288","type":"HCPCS"}],"standard_charges":[{"gross_charge":84281.0,"discounted_cash":50568.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37290 REVASC EVASC TPVT ATHRC UNI COMPLEX LESION, INITL-LT","code_information":[{"code":"4800581","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37290","type":"HCPCS"}],"standard_charges":[{"gross_charge":70754.0,"discounted_cash":42452.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37290 REVASC EVASC TPVT ATHRC UNI COMPLEX LESION, INITL-RT","code_information":[{"code":"4800582","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37290","type":"HCPCS"}],"standard_charges":[{"gross_charge":70754.0,"discounted_cash":42452.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37290 REVASC EVASC TPVT ATHRC UNI COMPLEX LESION, INITL-BLT","code_information":[{"code":"4800583","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37290","type":"HCPCS"}],"standard_charges":[{"gross_charge":106131.0,"discounted_cash":63678.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37296 REVASC EVASC IMVT ANGIO UNI STRAIGHTFRWRD LESION, INITL-LT","code_information":[{"code":"4800596","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37296","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37296 REVASC EVASC IMVT ANGIO UNI STRAIGHTFRWRD LESION, INITL-RT","code_information":[{"code":"4800597","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37296","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37296 REVASC EVASC IMVT ANGIO UNI STRAIGHTFRWRD LESION, INITL-BLT","code_information":[{"code":"4800598","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37296","type":"HCPCS"}],"standard_charges":[{"gross_charge":53073.0,"discounted_cash":31843.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37297 REVASC EVASC IMVT ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-LT","code_information":[{"code":"4800599","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37297","type":"HCPCS"}],"standard_charges":[{"gross_charge":21229.0,"discounted_cash":12737.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37297 REVASC EVASC IMVT ANGIO UNI STRAIGHTFRWRD LESION, EA ADD-RT","code_information":[{"code":"4800600","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37297","type":"HCPCS"}],"standard_charges":[{"gross_charge":21229.0,"discounted_cash":12737.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37298 REVASC EVASC IMVT ANGIO UNI COMPLEX LESION, INITL-LT","code_information":[{"code":"4800601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37298","type":"HCPCS"}],"standard_charges":[{"gross_charge":44067.0,"discounted_cash":26440.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37298 REVASC EVASC IMVT ANGIO UNI COMPLEX LESION, INITL-RT","code_information":[{"code":"4800602","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37298","type":"HCPCS"}],"standard_charges":[{"gross_charge":44067.0,"discounted_cash":26440.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37298 REVASC EVASC IMVT ANGIO UNI COMPLEX LESION, INITL-BLT","code_information":[{"code":"4800603","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37298","type":"HCPCS"}],"standard_charges":[{"gross_charge":66101.0,"discounted_cash":39660.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 37299 REVASC EVASC IMVT ANGIO UNI COMPLEX LESION, EA ADD-LT","code_information":[{"code":"4800604","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37299","type":"HCPCS"}],"standard_charges":[{"gross_charge":26440.0,"discounted_cash":15864.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 37299 REVASC EVASC IMVT ANGIO UNI COMPLEX LESION, EA ADD-RT","code_information":[{"code":"4800605","type":"CDM"},{"code":"0481","type":"RC"},{"code":"37299","type":"HCPCS"}],"standard_charges":[{"gross_charge":26440.0,"discounted_cash":15864.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 92930 PERC TRANSCATH PLMT INTRACORONARY 2+LES 2+STENTS 2+C SEGMENTS -RC","code_information":[{"code":"4800606","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92930 PERC TRANSCATH PLMT INTRACORONARY 2+LES 2+STENTS 2+C SEGMENTS -LC","code_information":[{"code":"4800607","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92930 PERC TRANSCATH PLMT INTRACORONARY 2+LES 2+STENTS 2+C SEGMENTS -LD","code_information":[{"code":"4800608","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92930 PERC TRANSCATH PLMT INTRACORONARY 2+LES 2+STENTS 2+C SEGMENTS -LM","code_information":[{"code":"4800609","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92930 PERC TRANSCATH PLMT INTRACORONARY 2+LES 2+STENTS 2+C SEGMENTS -RI","code_information":[{"code":"4800610","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92930","type":"HCPCS"}],"standard_charges":[{"gross_charge":56187.0,"discounted_cash":33712.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 92945 PERC TRANSLUMINAL REVSC CHRNC TOT OCCLS 1 ANTEGRD & RETROGRD-RC","code_information":[{"code":"4800611","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RC: Right coronary artery"}]},{"description":"HC 92945 PERC TRANSLUMINAL REVSC CHRNC TOT OCCLS 1 ANTEGRD & RETROGRD-LC","code_information":[{"code":"4800612","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LC: Left circumflex coronary artery"}]},{"description":"HC 92945 PERC TRANSLUMINAL REVSC CHRNC TOT OCCLS 1 ANTEGRD & RETROGRD-LD","code_information":[{"code":"4800613","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LD"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LD: Left anterior descending coronary artery"}]},{"description":"HC 92945 PERC TRANSLUMINAL REVSC CHRNC TOT OCCLS 1 ANTEGRD & RETROGRD-LM","code_information":[{"code":"4800614","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["LM"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier LM: Left main coronary artery"}]},{"description":"HC 92945 PERC TRANSLUMINAL REVSC CHRNC TOT OCCLS 1 ANTEGRD & RETROGRD-RI","code_information":[{"code":"4800615","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92945","type":"HCPCS"}],"standard_charges":[{"gross_charge":35382.0,"discounted_cash":21229.2,"setting":"both","modifier_code":["RI"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier RI: Ramus intermedius coronary artery"}]},{"description":"HC 0897T AGMNTN ARRHYTHMIA ANALYSIS QUANTITATIVE COMPUTE CARDIAC SIMUL, NONINVASIVE","code_information":[{"code":"4800617","type":"CDM"},{"code":"0481","type":"RC"},{"code":"0897T","type":"HCPCS"}],"standard_charges":[{"gross_charge":5462.0,"discounted_cash":3277.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10060 INC/DRN ABCSS/CYST SMPL SINGLE","code_information":[{"code":"5100001","type":"CDM"},{"code":"0510","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1276.0,"discounted_cash":765.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10120 INC/REMOVE FB, SUBCUT, SIMPLE","code_information":[{"code":"5100004","type":"CDM"},{"code":"0510","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":389.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10140 INC/DRN HEMATOMA, SEROMA, FLUID","code_information":[{"code":"5100005","type":"CDM"},{"code":"0510","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11000 DEBRIDE INFECTED SKIN UP TO 10-%","code_information":[{"code":"5100007","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11000","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":385.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11042 DEBRIDE SKIN/TISSUE FIRST 20 SQ CM OR LESS","code_information":[{"code":"5100010","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":669.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11043 DEBRIDE TISSUE/MUSCLE FIRST 20 SQ CM OR LESS","code_information":[{"code":"5100011","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1697.0,"discounted_cash":1018.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11044 DEBRIDE TISSUE/MUSCLE/BONE FIRST 20 SQ CM OR LESS","code_information":[{"code":"5100012","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":3709.0,"discounted_cash":2225.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11056 TRIM 2-4, BENIGN SKIN LESION","code_information":[{"code":"5100013","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11719 TRIM NAIL(S)","code_information":[{"code":"5100017","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.0,"discounted_cash":141.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11720 DEBRIDE NAIL 1-5","code_information":[{"code":"5100018","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11721 DEBRIDE NAIL 6 OR MORE","code_information":[{"code":"5100019","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11750 EXCIS NAIL/MATRIX,INGRN TOENAIL REM","code_information":[{"code":"5100020","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.0,"discounted_cash":621.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 17110 DEST FLAT WART/MOLLUS/MILIA UP TO 14","code_information":[{"code":"5100028","type":"CDM"},{"code":"0510","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 17250 CHEM CAUTERY GRANUAL TISSUE","code_information":[{"code":"5100029","type":"CDM"},{"code":"0510","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20550 INJECT SINGLE TENDON SHEATH LIG","code_information":[{"code":"5100030","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20551 INJECTION-SINGLE TENDON ORIGIN","code_information":[{"code":"5100031","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":599.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29580 STRAPPING,UNNA BOOT RT","code_information":[{"code":"5100035","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29580 STRAPPING,UNNA BOOT LT","code_information":[{"code":"5100036","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29580 STRAPPING,UNNA BOOT BLT","code_information":[{"code":"5100037","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":448.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 51701 INSERT NON-INDWELLING BLADDER CATH","code_information":[{"code":"5100040","type":"CDM"},{"code":"0510","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51702 INSERT INDWELLING BLADDER CATH","code_information":[{"code":"5100041","type":"CDM"},{"code":"0510","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 58301 REMOVL OF INTRAUTERIN DEVICE (IUD)","code_information":[{"code":"5100043","type":"CDM"},{"code":"0510","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.0,"discounted_cash":191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 59000 AMNIOCENTESIS DIAGNOSTIC","code_information":[{"code":"5100044","type":"CDM"},{"code":"0510","type":"RC"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1329.0,"discounted_cash":797.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 59025 FETAL NON-STRESS TEST","code_information":[{"code":"5100045","type":"CDM"},{"code":"0510","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":622.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62270 SPINAL PUNCTURE,LUMBAR, DIAGNOSTIC","code_information":[{"code":"5100049","type":"CDM"},{"code":"0510","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1971.0,"discounted_cash":1182.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95990 REFILL/MAINT, IMPLANT PUMP FOR DRUG DELV","code_information":[{"code":"5100063","type":"CDM"},{"code":"0510","type":"RC"},{"code":"95990","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"discounted_cash":598.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97597 SELECT DEBRIDEMENT FIRST 20 SQ CM OR <","code_information":[{"code":"5100066","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97597 SELECT DEBRIDEMENT FIRST 20 SQ CM OR <","code_information":[{"code":"5100067","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97598 SELECT DEBRIDEMENT EA ADD 20 SQ CM","code_information":[{"code":"5100068","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":358.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97598 SELECT DEBRIDEMENT EA ADD 20 SQ CM","code_information":[{"code":"5100069","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97602 NON-SELECT DEBRIDE W/O ANES,PER VISIT","code_information":[{"code":"5100070","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97602","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":342.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98925 OSTEOPATHIC MANIPULATIVE TX (OMT) 1-2 REGION","code_information":[{"code":"5100073","type":"CDM"},{"code":"0510","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99202 OP VISIT NEW PT LEVEL II","code_information":[{"code":"5100081","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99203 OP VISIT NEW PT LEVEL III","code_information":[{"code":"5100088","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99204 OP VISIT NEW PT LEVEL IV","code_information":[{"code":"5100092","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":363.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99205 OP VISIT NEW PT LEVEL V","code_information":[{"code":"5100096","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":792.0,"discounted_cash":475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99211 OP VISIT EST PT LEVEL I","code_information":[{"code":"5100102","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99212 OP VISIT EST PT LEVEL II","code_information":[{"code":"5100109","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.0,"discounted_cash":116.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99213 OP VISIT EST PT LEVEL III","code_information":[{"code":"5100117","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99214 OP VISIT EST PT LEVEL IV","code_information":[{"code":"5100125","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99215 OP VISIT EST PT LEVEL V","code_information":[{"code":"5100131","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":694.0,"discounted_cash":416.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99242 OP CONSULTATION LEVEL II","code_information":[{"code":"5100139","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99243 OP CONSULTATION LEVEL  III","code_information":[{"code":"5100142","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":154.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99244 OP CONSULTATION LEVEL IV","code_information":[{"code":"5100144","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":179.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99245 OP CONSULTATION LEVEL V","code_information":[{"code":"5100146","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64681 DEST NEURO AGNT SUP HYPO PLEXUS,W/WO RAD RT","code_information":[{"code":"5100169","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64681","type":"HCPCS"}],"standard_charges":[{"gross_charge":6150.0,"discounted_cash":3690.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20552 INJ SGL/MULTI TRIGGER 1 OR 2 MUSCLE","code_information":[{"code":"5100181","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.0,"discounted_cash":628.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20553 INJ SGL/MULTI TRIGGER PTS 3/+ MSCL","code_information":[{"code":"5100182","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1521.0,"discounted_cash":912.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27096 INJ ANESTH SACROILIAC - RT","code_information":[{"code":"5100187","type":"CDM"},{"code":"0511","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.0,"discounted_cash":1083.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 62273 INJ EPIDURAL,BLOOD/CLOT PATCH","code_information":[{"code":"5100188","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62273","type":"HCPCS"}],"standard_charges":[{"gross_charge":3065.0,"discounted_cash":1839.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64400 INJ ANES TRIGEMINAL NERVE ANY BRANC - RT","code_information":[{"code":"5100196","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":638.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64405 INJ ANES GREATER OCCIPITAL NERVE - RT","code_information":[{"code":"5100198","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":672.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64420 INJ,ANESTH INTERCOSTAL NRVE,SGL","code_information":[{"code":"5100203","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64421 INJ,ANESTH INTERCOSTAL NRVE, EA ADDTL LVL - RT","code_information":[{"code":"5100205","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.0,"discounted_cash":1666.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64421 INJ,ANESTH INTERCOSTAL NRVE, EA ADDTL LVL - LT","code_information":[{"code":"5100206","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2778.0,"discounted_cash":1666.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64425 INJ,ANS ILIOINGUINAL/HYPOGASTRIC RT","code_information":[{"code":"5100207","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":672.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64425 INJ,ANS ILIOINGUINAL/HYPOGASTRIC LT","code_information":[{"code":"5100208","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":672.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64447 INJ, FEMORAL NERVE,SINGLE-RT","code_information":[{"code":"5100209","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1613.0,"discounted_cash":967.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64447 INJ, FEMORAL NERVE,SINGLE-LT","code_information":[{"code":"5100210","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1613.0,"discounted_cash":967.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64450 INJ, ANES PERIPHERAL NRV/BRANCH -RT","code_information":[{"code":"5100211","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":970.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64450 INJ, ANES PERIPHERAL NRV/BRANCH -LT","code_information":[{"code":"5100212","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":970.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64483 INJ TRANSFORAMINAL LUM/SCR SINGLE - RT","code_information":[{"code":"5100221","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3113.0,"discounted_cash":1867.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64484 INJ TRANSFORAMINAL LUM/SCR EA ADD' - RT","code_information":[{"code":"5100222","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.0,"discounted_cash":951.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64510 INJ ANESTH STELLATE GANG BLOCK","code_information":[{"code":"5100223","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":3017.0,"discounted_cash":1810.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64520 INJ ANESTH LUMBR/THOR SYMPAT BLOCK","code_information":[{"code":"5100224","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":3065.0,"discounted_cash":1839.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64600 DEST TRIGEMINAL NRV-SUPORB/INFORB","code_information":[{"code":"5100225","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64600","type":"HCPCS"}],"standard_charges":[{"gross_charge":4040.0,"discounted_cash":2424.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64620 DEST INTERCOSTAL NERVE","code_information":[{"code":"5100229","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":4196.0,"discounted_cash":2517.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64640 DEST OTH PERIPH NERVE/BRANCH - RT","code_information":[{"code":"5100234","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":4196.0,"discounted_cash":2517.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 12032 LAYER CLOS,SCLP,AXL,TRK,EXT,2.6-7.5","code_information":[{"code":"5100270","type":"CDM"},{"code":"0510","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":958.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12051 LAYR CLO,FCE,EAR,EYE,NSE,LP,MM<=2.5","code_information":[{"code":"5100274","type":"CDM"},{"code":"0510","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":461.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12052 LAYR CLO,FA,EAR,EYE,NSE,LP,MM<=2.6-5","code_information":[{"code":"5100275","type":"CDM"},{"code":"0510","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":430.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 46050 INCIS/DRAIN PERIANAL ABSCESS,SUPFSC","code_information":[{"code":"5100311","type":"CDM"},{"code":"0510","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":574.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51741 COMPLEX UROFLOWMETRY (CALIB ELECT)","code_information":[{"code":"5100339","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51741","type":"HCPCS"}],"standard_charges":[{"gross_charge":1097.0,"discounted_cash":658.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EMG-ANAL/URETHRAL SPHINCTER","code_information":[{"code":"5100341","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VOIDING PRESSURE STUDIES-INTRA-ABDOMINAL","code_information":[{"code":"5100342","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51797","type":"HCPCS"}],"standard_charges":[{"gross_charge":2415.0,"discounted_cash":1449.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62367 ELECT ANLYS IMPLNTD PUMP WO REPROG/REFILL","code_information":[{"code":"5100343","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62367","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ANALYZE IMPLANTED PUMP,W/REPROGRAMING","code_information":[{"code":"5100344","type":"CDM"},{"code":"0920","type":"RC"},{"code":"62368","type":"HCPCS"}],"standard_charges":[{"gross_charge":698.0,"discounted_cash":418.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95250 CONTINUOUS GLUCOSE MONITOR SYSTEM 3-DAY","code_information":[{"code":"5100348","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95857 TENSILON TEST FOR MYASTHENIA GRAVIS","code_information":[{"code":"5100353","type":"CDM"},{"code":"0510","type":"RC"},{"code":"95857","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.0,"discounted_cash":385.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27096 INJ ANESTH SACROILIAC LT","code_information":[{"code":"5100354","type":"CDM"},{"code":"0511","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.0,"discounted_cash":1083.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64400 INJ ANES TRIGEMINAL NERVE ANY BRANCH LT","code_information":[{"code":"5100355","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1064.0,"discounted_cash":638.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64405 INJ ANES GREATER OCCIPITAL NERVE LT","code_information":[{"code":"5100357","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":672.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64415 INJECT ANES AGNT;BRACHIAL PLEX NERVE RT","code_information":[{"code":"5100358","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":5717.0,"discounted_cash":3430.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64415 INJECT ANES AGNT;BRACHIAL PLEX NERVE LT","code_information":[{"code":"5100359","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":5717.0,"discounted_cash":3430.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64445 INJECT ANES AGNT; SCIATIC NERVE RT","code_information":[{"code":"5100360","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":3065.0,"discounted_cash":1839.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64445 INJECT ANES AGNT; SCIATIC NERVE LT","code_information":[{"code":"5100361","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":3065.0,"discounted_cash":1839.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64483 INJ TRANSFORAMINAL LUM/SCR SINGLE LT","code_information":[{"code":"5100362","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":3113.0,"discounted_cash":1867.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64484 INJ TRANSFORAMINAL LUM/SCR EA ADD LT","code_information":[{"code":"5100363","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":1586.0,"discounted_cash":951.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64530 INJECT,ANES AGNT;CELIAC PLEXUS","code_information":[{"code":"5100364","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":3830.0,"discounted_cash":2298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22526 PERC INTRADISCAL, ELECT ANNULOPLASTY UNI/BIL, SNG","code_information":[{"code":"5100365","type":"CDM"},{"code":"0511","type":"RC"},{"code":"22526","type":"HCPCS"}],"standard_charges":[{"gross_charge":4553.0,"discounted_cash":2731.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62287 PERC DISC DECOMPRESS SGL/MULT LVL LUMB","code_information":[{"code":"5100366","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62287","type":"HCPCS"}],"standard_charges":[{"gross_charge":14827.0,"discounted_cash":8896.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62290 INJ PRO DISKOGRAPHY EA LEVEL LUMBAR","code_information":[{"code":"5100367","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62290","type":"HCPCS"}],"standard_charges":[{"gross_charge":4042.0,"discounted_cash":2425.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62291 INJ  DISKOGRAPHY EA LVL, CERVICAL OR THORACIC","code_information":[{"code":"5100368","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3518.0,"discounted_cash":2110.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64640 DEST OTH PERIPH NERVE/BRANCH-LT","code_information":[{"code":"5100375","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":4196.0,"discounted_cash":2517.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64680 DEST NEURO AGENT CELIAC PLEXUS,W/WO RAD","code_information":[{"code":"5100376","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64680","type":"HCPCS"}],"standard_charges":[{"gross_charge":4866.0,"discounted_cash":2919.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64490 INJ PARAVERT AGNT CERVICAL/THORACIC RT","code_information":[{"code":"5100395","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3743.0,"discounted_cash":2245.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64490 INJ PARAVERT AGNT CERVICAL/THORACIC LT","code_information":[{"code":"5100396","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3743.0,"discounted_cash":2245.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64491 INJ PARAVERT AGNT CERV/THOR 2ND LEVEL RT","code_information":[{"code":"5100397","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1337.0,"discounted_cash":802.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64491 INJ PARAVERT AGNT CERV/THOR 2ND LEVEL LT","code_information":[{"code":"5100398","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1337.0,"discounted_cash":802.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64492 INJ AGNT PARAVERT CERV/THOR 3RD LEVEL RT","code_information":[{"code":"5100399","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64492 INJ AGNT PARAVERT CERV/THOR 3RD LEVEL LT","code_information":[{"code":"5100400","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64493 INJ AGNT PARAVERT LUM/SCRL SNG LEVEL RT","code_information":[{"code":"5100401","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.0,"discounted_cash":1951.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64493 INJ AGNT PARAVERT LUM/SCRL SNG LEVEL LT","code_information":[{"code":"5100402","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":3253.0,"discounted_cash":1951.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64494 INJ AGNT PARAVERT LUM/SCRL 2ND LEVEL RT","code_information":[{"code":"5100403","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":698.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64494 INJ AGNT PARAVERT LUM/SCRL 2ND LEVEL LT","code_information":[{"code":"5100404","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":698.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64495 INJ AGNT PARAVERT LUM/SCRL 3RD LEVEL RT","code_information":[{"code":"5100405","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":1044.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64495 INJ AGNT PARAVERT LUM/SCRL 3RD LEVEL LT","code_information":[{"code":"5100406","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":1044.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29581 WC APP MULTI LAYER COMPRS LOWER LEG RT","code_information":[{"code":"5100407","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29581 WC APP MULTI LAYER COMPRS LOWER LEG LT","code_information":[{"code":"5100408","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29581 WC APP MULTI LAYER COMPRS LOWER LEG BLT","code_information":[{"code":"5100409","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":730.0,"discounted_cash":438.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 11732 REMOVAL,ADDL NAIL PLATE,SIMPLE, SNGL","code_information":[{"code":"5100419","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11730 REM NAIL PLATE SIMPLE SINGLE","code_information":[{"code":"5100432","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":277.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29445 APP RIGID TOTAL CONTACT LEG CAST","code_information":[{"code":"5100443","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1271.0,"discounted_cash":762.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64450 INS ANES PERIPHERAL NRV/BRANCH BLT","code_information":[{"code":"5100454","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2422.0,"discounted_cash":1453.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64483 INJ TRANSFORMINAL LUM/SCR SGL BLT","code_information":[{"code":"5100456","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":4673.0,"discounted_cash":2803.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64484 INJ TRANSFORMINAL LUM/SCR EA ADD BLT","code_information":[{"code":"5100457","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":2376.0,"discounted_cash":1425.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64490 INJ PARAVERT AGNT CERVICAL/THORACIC BLT","code_information":[{"code":"5100458","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":5610.0,"discounted_cash":3366.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64491 INJ PARAVERT AGNT CERV/THOR 2ND LEVEL BLT","code_information":[{"code":"5100459","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.0,"discounted_cash":1201.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64492 INJ AGNT PARAVERT CERV/THOR 3RD LEVEL BLT","code_information":[{"code":"5100460","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":1263.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64493 INJ AGNT PARAVERT LUM/SCRL SGL LEVEL BLT","code_information":[{"code":"5100461","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":4879.0,"discounted_cash":2927.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64494 INJ AGNT PARAVERT LUM/SCRL 2ND LEVEL BLT","code_information":[{"code":"5100462","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":1044.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64495 INJ AGNT PARAVERT LUM/SCRL 3RD LEVEL BLT","code_information":[{"code":"5100463","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":2962.0,"discounted_cash":1777.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64640 DEST OTH PERIPH NERVE/BRANCH - BLT","code_information":[{"code":"5100468","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":6300.0,"discounted_cash":3780.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64430 INJ ANEST AGNT PUDENDAL NERVE LT","code_information":[{"code":"5100469","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3743.0,"discounted_cash":2245.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64681 DEST NEURO AGNT SUP HYPO PLEXUS,W/WO RAD LT","code_information":[{"code":"5100470","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64681","type":"HCPCS"}],"standard_charges":[{"gross_charge":6150.0,"discounted_cash":3690.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 11045 DEBRIDE SUBQ TISSUE; EA ADD 20 SQ CM","code_information":[{"code":"5100483","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1005.0,"discounted_cash":603.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11046 DEBRIDE MUSCLE &/OR FASCIA EA ADD 20 SQ CM","code_information":[{"code":"5100484","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.0,"discounted_cash":759.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64505 INJ ANES AGENT SPHENOPALATINE GANGLION","code_information":[{"code":"5100485","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64505","type":"HCPCS"}],"standard_charges":[{"gross_charge":946.0,"discounted_cash":567.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11047 DEBRIDE BONE MUSCLE&/OR FASCIA EA ADD 20 SQ CM","code_information":[{"code":"5100490","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.0,"discounted_cash":1518.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11047 DEBRIDE BONE MUSCL &/OR FASCIA EA ADD 20 SQ CM","code_information":[{"code":"5100497","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.0,"discounted_cash":1518.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64517 INJ ANES AGENT SUP HYPOGASTRIC PLEX - RT","code_information":[{"code":"5100511","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":3923.0,"discounted_cash":2353.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64517 INJ ANES AGENT SUP HYPOGASTRIC PLEX - LT","code_information":[{"code":"5100512","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":3923.0,"discounted_cash":2353.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27096 INJ ANESTH SACROILIAC - BLT","code_information":[{"code":"5100516","type":"CDM"},{"code":"0511","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":3898.0,"discounted_cash":2338.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64405 INJ ANES GREATER OCCIPITAL NERVE -BLT","code_information":[{"code":"5100517","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1003.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION; SINGLE LESION","code_information":[{"code":"5100518","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15271 APP HIGH COST SKIN SUB TRUNK,ARMS,LEGS FIRST 25 SQ CM","code_information":[{"code":"5100526","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2769.0,"discounted_cash":1661.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15272 APP HIGH COST SKIN SUB TRUNK,ARMS,LEGS EA ADDTL 25 SQCM","code_information":[{"code":"5100527","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.0,"discounted_cash":646.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15273 APP HIGH COST SKIN SUB TRUNK,ARMS,LEGS 1ST 100 SQ CM","code_information":[{"code":"5100528","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15273","type":"HCPCS"}],"standard_charges":[{"gross_charge":4562.0,"discounted_cash":2737.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15274 APP HIGH COST SKIN SUB TRUNK,ARMS,LEGS EA ADDTL 100 SQ CM","code_information":[{"code":"5100529","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15274","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1141.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15275 APP HIGH COST SKIN SUB FACE,HAND,FEET,GENITAL 1ST 25 SQ CM","code_information":[{"code":"5100530","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":2769.0,"discounted_cash":1661.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15276 APP HIGH COST SKIN SUB FACE,HAND,FEET,GENITAL EA ADDTL 25 SQ CM","code_information":[{"code":"5100531","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15276","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.0,"discounted_cash":646.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15277 APP HIGH COST SKIN SUB FACE,HAND,FEET,GENITAL 1ST 100 SQ CM","code_information":[{"code":"5100532","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15277","type":"HCPCS"}],"standard_charges":[{"gross_charge":2769.0,"discounted_cash":1661.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15278 APP HIGH COST SKIN SUB FACE,HAND,FEET,GENITAL EA ADDTL 100 SQ CM","code_information":[{"code":"5100533","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1213.0,"discounted_cash":727.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64633 DEST NERVE PARAVERT FACET CERV/THOR SNGL-RT","code_information":[{"code":"5100534","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.0,"discounted_cash":2276.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64633 DEST NERVE PARAVERT FACET CERV/THOR SNGL-LT","code_information":[{"code":"5100535","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.0,"discounted_cash":2276.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64633 DEST NERVE PARAVERT FACET CERV/THOR SNGL-BLT","code_information":[{"code":"5100536","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":5688.0,"discounted_cash":3412.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64634 DEST NERVE PARAVERT FACET CERV/THOR EA ADD LVL-RT","code_information":[{"code":"5100537","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1849.0,"discounted_cash":1109.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64634 DEST NERVE PARAVERT FACET CERV/THOR EA ADD LVL-LT","code_information":[{"code":"5100538","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1849.0,"discounted_cash":1109.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64634 DEST NERVE PARAVERT FACET CERV/THOR EA ADD LVL-BLT","code_information":[{"code":"5100539","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.0,"discounted_cash":1527.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64635 DEST NERVE PARAVERT FACET LUMB/SACR SNGL-RT","code_information":[{"code":"5100540","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.0,"discounted_cash":2276.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64635 DEST NERVE PARAVERT FACET LUMB/SACR SNGL-LT","code_information":[{"code":"5100541","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.0,"discounted_cash":2276.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64635 DEST NERVE PARAVERT FACET LUMB/SACR SNGL-BLT","code_information":[{"code":"5100542","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":5688.0,"discounted_cash":3412.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64636 DEST NERVE PARAVERT FACET LUMB/SACR EA ADDTL LVL-RT","code_information":[{"code":"5100543","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1759.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64636 DEST NERVE PARAVERT FACET LUMB/SACR EA ADDTL LVL-LT","code_information":[{"code":"5100544","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":2933.0,"discounted_cash":1759.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64636 DEST NERVE PARAVERT FACET LUMB/SACR EA ADDTL LVL","code_information":[{"code":"5100545","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":4398.0,"discounted_cash":2638.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29584 APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND-RT","code_information":[{"code":"5100550","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":262.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 62369 ELECTRONIC ANALYSIS PUMP W REPROGRAM/REFILL","code_information":[{"code":"5100551","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62369","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.0,"discounted_cash":760.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29584 APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND-LT","code_information":[{"code":"5100554","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":437.0,"discounted_cash":262.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29584 APPL MULTILAYER COMPRESS SYST UPPER ARM/HAND-BLT","code_information":[{"code":"5100557","type":"CDM"},{"code":"0510","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":391.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64615 CHEMODENERVATION OF MUSCLE(S) BILATERAL","code_information":[{"code":"5100588","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69210 REMOVE IMPACT CERUMEN W/INSTRUMENTS-BLT","code_information":[{"code":"5100635","type":"CDM"},{"code":"0510","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 28232 TENOTOMY OPEN TENDON FLEXOR TOE SINGLE TENDON","code_information":[{"code":"5100674","type":"CDM"},{"code":"0510","type":"RC"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":6478.0,"discounted_cash":3886.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97607 NEGATIVE PRESSURE WOUND THERAPY; NON DME; </= 50 SQ CM","code_information":[{"code":"5100687","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97608 NEGATIVE PRESSURE WOUND THERAPY; NON DME; > 50 SQ CM","code_information":[{"code":"5100688","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97608","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":357.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE - LT","code_information":[{"code":"5100689","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 97605 NEGATIVE PRESSURE WOUND TX <=50 SQ CM-UTILIZE DME","code_information":[{"code":"5100690","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.0,"discounted_cash":189.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE-RT","code_information":[{"code":"5100691","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE-LT","code_information":[{"code":"5100692","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN  W/O US GUIDE-RT","code_information":[{"code":"5100693","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE","code_information":[{"code":"5100694","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 INJ ARTHRO,MAJOR JT/BURSA/GAN W/O US GUIDE-BIL","code_information":[{"code":"5100697","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1930.0,"discounted_cash":1158.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20610 INJ/ARTHRO,MAJOR JT/BURSA/GAN; WO GUIDE-RT","code_information":[{"code":"5100699","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 INJ/ARTHRO,MAJOR JT/BURSA/GAN; WO GUIDE-LT","code_information":[{"code":"5100700","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20600 ARTHROCENT SM JNT/BURS/GAN W/O US GUIDE-RT","code_information":[{"code":"5100704","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20600 ARTHROCENT SM JNT/BURS/GAN W/O US GUIDE-LT","code_information":[{"code":"5100705","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97606 PT NEGATIVE PRESSURE WOUND TX >50 SQ CM-UTILIZE DME","code_information":[{"code":"5100706","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":656.0,"discounted_cash":393.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64486 TRANS ABD PLANE (TAP) BLOCK; UNILAT, INC IMAG-RT","code_information":[{"code":"5100708","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64486 TRANS ABD PLANE (TAP) BLOCK; UNILAT, INC IMAG-LT","code_information":[{"code":"5100709","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64488 TRANS ABD PLANE (TAP) BLOCK; BILAT, INC IMAGING","code_information":[{"code":"5100710","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2708.0,"discounted_cash":1624.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10121 INC/REMOVE FB, SUBCUT, COMPLEX","code_information":[{"code":"5100744","type":"CDM"},{"code":"0510","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69209 REMOVE IMPACT CERUMEN W/LAVAGE-RT","code_information":[{"code":"5100783","type":"CDM"},{"code":"0510","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 69209 REMOVE IMPACT CERUMEN W/LAVAGE-LT","code_information":[{"code":"5100784","type":"CDM"},{"code":"0510","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 99495 TRANSITIONAL CARE MGMT SRVS W/I 14 DAYS-FAC","code_information":[{"code":"5100788","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99496 TRANSITIONAL CARE MGMT SRVS W/I 7 DAYS-FAC","code_information":[{"code":"5100789","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36593 DECLOT BY THROMBOLYTIC IMPLANTED VASC DEV/CATH","code_information":[{"code":"5100790","type":"CDM"},{"code":"0510","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1843.0,"discounted_cash":1105.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62320 EPIDURAL NJX, CERV/THORACIC W/O IMAGING","code_information":[{"code":"5100791","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":5956.0,"discounted_cash":3573.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62321 EPIDURAL NJX,  CERV/THORACIC, WITH IMAGING","code_information":[{"code":"5100792","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":8277.0,"discounted_cash":4966.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62322 EPIDURAL NJX, LUMBAR/SACRAL W/O IMAGING","code_information":[{"code":"5100793","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2570.0,"discounted_cash":1542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62323 EPIDURAL NJX, LUMBAR/SACRAL WITH IMAGING","code_information":[{"code":"5100794","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":3225.0,"discounted_cash":1935.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62324 EPIDURAL INFUSION, CERVICAL OR THORACIC - NO IMAGING","code_information":[{"code":"5100795","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":5670.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62325 EPIDURAL INFUSION, CERVICAL OR THORACIC - WITH IMAGING","code_information":[{"code":"5100796","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62325","type":"HCPCS"}],"standard_charges":[{"gross_charge":9061.0,"discounted_cash":5436.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62326 EPIDURAL INFUSION, LUMBAR/SACRAL - NO IMAGING","code_information":[{"code":"5100797","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":5670.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62327 EPIDURAL INFUSION, LUMBAR/SACRAL - WITH IMAGING","code_information":[{"code":"5100798","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":9061.0,"discounted_cash":5436.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99151 MODERATE SEDATION, SAME QHP, 1ST 15 MIN, <5 YRS","code_information":[{"code":"5100799","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":551.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99152 MODERATE SEDATION, SAME QHP, 1ST 15 MIN, 5/>YRS","code_information":[{"code":"5100800","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":599.0,"discounted_cash":359.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99153 MODERATE SEDATION, SAME QHP,  EACH ADDL 15 MIN","code_information":[{"code":"5100801","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.0,"discounted_cash":569.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99155 MODERATE SEDATION, OTHER QHP, 1ST 15 MIN, <5 YRS","code_information":[{"code":"5100802","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":499.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99156 MODERATE SEDATION, OTHER QHP, 1ST 15 MIN, 5/>YRS","code_information":[{"code":"5100803","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":499.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99157 MODERATE SEDATION, OTHER QHP, EACH ADDL 15 MIN","code_information":[{"code":"5100804","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":839.0,"discounted_cash":503.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96160 HEALTH RISK ASSESS,PT-FOCUSED","code_information":[{"code":"5100805","type":"CDM"},{"code":"0510","type":"RC"},{"code":"96160","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96161 HEALTH RISK ASSESS,CARE GIVER-FOCUSED","code_information":[{"code":"5100806","type":"CDM"},{"code":"0510","type":"RC"},{"code":"96161","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99401 PREVENT MED COUNSELING APPROX 15 MIN","code_information":[{"code":"5100811","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99401","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11401 EXCISION BENIGN LESION INC MARGINS, EXC SKIN TAG, TRK/ARM/LEG  .6 - 1CM","code_information":[{"code":"5100852","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11401","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11403 EXCISION BENIGN LESION INC MARGIN, EXC SKIN TAG, TRK/ARM/LEG 2.1-3.0 CM","code_information":[{"code":"5100854","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1931.0,"discounted_cash":1158.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11420 EXCISION BENIGN LESION W MARGIN, EXC SKIN TAG, S/N/H/F/G; DIAM 0.5 CM/<","code_information":[{"code":"5100857","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.0,"discounted_cash":1201.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11421 EXCISION BENIGN LESION W MARGIN, EXC SKIN TAG, S/N/H/F/G; 0.6-1.0CM","code_information":[{"code":"5100858","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.0,"discounted_cash":1201.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11422 EXCISION BENIGN LESION W MARGIN, EXC SKIN TAG, S/N/H/F/G; 1.1-2.0CM","code_information":[{"code":"5100859","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11423 EXCISION BENIGN LESION W MARGIN, EXC SKIN TAG, S/N/H/F/G; 2.1-3.0CM","code_information":[{"code":"5100860","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11424 EXCISION BENIGN LESION W MARGIN, EXC SKIN TAG, S/N/H/F/G; 3.1-4.0CM","code_information":[{"code":"5100861","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11426 EXCISION BENIGN LESION W MARGIN, EXC SKIN TAG, S/N/H/F/G; > 4.0CM","code_information":[{"code":"5100862","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11426","type":"HCPCS"}],"standard_charges":[{"gross_charge":3367.0,"discounted_cash":2020.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11440 EXCISION BENIGN LESION INC MARGIN, EXC SKIN TAG, F/E/E/N/L/M; 0.5CM/<","code_information":[{"code":"5100863","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11440","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":547.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11441 EXCISION BENIGN LESION INC MARGIN, EXC SKIN TAG, F/E/E/N/L/M; 0.6-1.0CM","code_information":[{"code":"5100864","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11441","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":547.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11442 EXCISION BENIGN LESION INC MARGIN, EXC SKIN TAG, F/E/E/N/L/M; 1.1-2.0CM","code_information":[{"code":"5100865","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11442","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":547.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11443 EXCISION BENIGN LESION INC MARGIN, EXC SKIN TAG, F/E/E/N/L/M; 2.1-3.0CM","code_information":[{"code":"5100866","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11443","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1223.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11643 EXCISION MALIGNANT LESION INC MARGIN, F/E/E/N/L; DIAM 2.1-3.0 CM","code_information":[{"code":"5100884","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11643","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1223.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11644 EXCISION MALIGNANT LESION INC MARGIN, F/E/E/N/L; DIAM 3.1-4.0 CM","code_information":[{"code":"5100885","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11644","type":"HCPCS"}],"standard_charges":[{"gross_charge":2039.0,"discounted_cash":1223.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11755 BIOPSY OF NAIL UNIT (SEPARATE PROCEDURE)","code_information":[{"code":"5100887","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1731.0,"discounted_cash":1038.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 17111 DESTRUCTION, OF BENIGN LESIONS; 15 OR MORE LESIONS","code_information":[{"code":"5100893","type":"CDM"},{"code":"0510","type":"RC"},{"code":"17111","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":268.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 40808 BIOPSY, VESTIBULE OF MOUTH","code_information":[{"code":"5100956","type":"CDM"},{"code":"0510","type":"RC"},{"code":"40808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":799.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51798 MEASURE POST-VOID RESIDUAL URINE &/OR BLADDER CAPACITY US, NON-IMAGING","code_information":[{"code":"5100972","type":"CDM"},{"code":"0510","type":"RC"},{"code":"51798","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 69100 BIOPSY EXTERNAL EAR","code_information":[{"code":"5100988","type":"CDM"},{"code":"0510","type":"RC"},{"code":"69100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.0,"discounted_cash":942.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC Q3014 TELEHEALTH ORIGINATING SITE FACILITY FEE","code_information":[{"code":"5100992","type":"CDM"},{"code":"0780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41010 INCISION LINGUAL FRENUM (FRENOTOMY)","code_information":[{"code":"5101051","type":"CDM"},{"code":"0510","type":"RC"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":3204.0,"discounted_cash":1922.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99402 PREVENT MED COUNSELING APPROX 30 MIN","code_information":[{"code":"5101104","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99402","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11102 TANGENTIAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"5101166","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11102","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11104 PUNCH BIOPSY SKIN SINGLE LESION","code_information":[{"code":"5101167","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.0,"discounted_cash":324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11106 INCISIONAL BIOPSY SKIN SINGLE LESION","code_information":[{"code":"5101168","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11106","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.0,"discounted_cash":370.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95976 ELEC ALYS IMPLT SMPL CRANIAL NERVE NPGT PRGRMG","code_information":[{"code":"5101178","type":"CDM"},{"code":"0510","type":"RC"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1442.0,"discounted_cash":865.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95977 ELEC ALYS IMPLT CPLX CRANIAL NERVE NPGT PRGRMG","code_information":[{"code":"5101179","type":"CDM"},{"code":"0510","type":"RC"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.0,"discounted_cash":493.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE)","code_information":[{"code":"5101182","type":"CDM"},{"code":"0510","type":"RC"},{"code":"52000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2192.0,"discounted_cash":1315.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11200 REMOVAL OF SKIN TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS","code_information":[{"code":"5101183","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11200","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62328 DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"5101213","type":"CDM"},{"code":"0510","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2699.0,"discounted_cash":1619.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64454 INJ ANES AGNT AND/OR STRD, GENICULAR NERVE BRANCHES W/IMG - LT","code_information":[{"code":"5101223","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":2973.0,"discounted_cash":1783.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64454 INJ ANES AGNT AND/OR STRD, GENICULAR NERVE BRANCHES W/IMG - RT","code_information":[{"code":"5101224","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":2973.0,"discounted_cash":1783.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64454 INJ ANES AGNT AND/OR STRD, GENICULAR NERVE BRANCHES W/IMG - BLT","code_information":[{"code":"5101225","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":4459.0,"discounted_cash":2675.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20600 ARTHROCENT SM JNT/BURS/GAN W/O US GUIDE-BLT","code_information":[{"code":"5101291","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":676.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 28090 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT - LT","code_information":[{"code":"5101349","type":"CDM"},{"code":"0510","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":3201.0,"discounted_cash":1920.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28090 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT - RT","code_information":[{"code":"5101350","type":"CDM"},{"code":"0510","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":3201.0,"discounted_cash":1920.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28090 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT - BLT","code_information":[{"code":"5101351","type":"CDM"},{"code":"0510","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":4802.0,"discounted_cash":2881.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 99426 PRINCIPAL CARE MGMT SVC CLINICAL STAFF TIME PER CAL MONTH, 1ST 30 MIN","code_information":[{"code":"5101380","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99426","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99427 PRINCIPAL CARE MGMT SVC CLINICAL STAFF TIME PER CAL MONTH, EA ADDL 30 MIN","code_information":[{"code":"5101381","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99427","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0023 PRINCIPAL NAVIGATION SVC AUX STAFF TIME PER CAL MONTH, 60 MIN TTL","code_information":[{"code":"5101382","type":"CDM"},{"code":"0510","type":"RC"},{"code":"G0023","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE - RT","code_information":[{"code":"5101537","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1156.0,"discounted_cash":693.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE - BLT","code_information":[{"code":"5101538","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.0,"discounted_cash":1040.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 11900 INJ INTRALESIONAL, UP TO & INCL 7 LESIONS","code_information":[{"code":"5101539","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11900","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20610 INJ ARTHRO,MAJOR JT/BURSA/GAN W/O US GUIDE - BLT","code_information":[{"code":"5101542","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1605.0,"discounted_cash":963.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20610 INJ/ARTHRO,MAJOR JT/BURSA/GAN; WO GUIDE - RT","code_information":[{"code":"5101543","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":642.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 INJ/ARTHRO,MAJOR JT/BURSA/GAN; WO GUIDE - LT","code_information":[{"code":"5101544","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1070.0,"discounted_cash":642.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64788 EXC NEUROFIBROMA OR NEUROLEMMOMA, CUTANEOUS NERVE","code_information":[{"code":"5101552","type":"CDM"},{"code":"0510","type":"RC"},{"code":"64788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2529.0,"discounted_cash":1517.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 52287 CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER","code_information":[{"code":"5101555","type":"CDM"},{"code":"0510","type":"RC"},{"code":"52287","type":"HCPCS"}],"standard_charges":[{"gross_charge":4508.0,"discounted_cash":2704.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51715 ENDOSCOPIC INJECT IMPLNT MATRL URETHA &/OR BLADDER NECK","code_information":[{"code":"5101556","type":"CDM"},{"code":"0510","type":"RC"},{"code":"51715","type":"HCPCS"}],"standard_charges":[{"gross_charge":7243.0,"discounted_cash":4345.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20600 ARTHRO,SM JT/BURSA/GANGLION W/O US GUIDE - LT","code_information":[{"code":"5101558","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":657.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20600 ARTHRO,SM JT/BURSA/GANGLION W/O US GUIDE - RT","code_information":[{"code":"5101559","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1095.0,"discounted_cash":657.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20600 ARTHRO,SM JT/BURSA/GANGLION W/O US GUIDE - BLT","code_information":[{"code":"5101560","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1643.0,"discounted_cash":985.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 15220 FULL THICK SKIN GRAFT TO SCALP ARM &/OR LEG 20.0 SQ CM OR LESS","code_information":[{"code":"5101563","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15221 FULL THICK SKIN GRAFT TO SCALP ARM &/OR LEG EA ADDL 20.0 SQ CM","code_information":[{"code":"5101564","type":"CDM"},{"code":"0510","type":"RC"},{"code":"15221","type":"HCPCS"}],"standard_charges":[{"gross_charge":2016.0,"discounted_cash":1209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20553 INJ SGL/MULTI TRIGGER PTS 3/MORE MUSCLE","code_information":[{"code":"5101570","type":"CDM"},{"code":"0510","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":1365.0,"discounted_cash":819.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64421 INJ ANES AGENT &/OR STEROID INTERCOSTAL NERVE EA ADD LVL","code_information":[{"code":"5101571","type":"CDM"},{"code":"0510","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":3411.0,"discounted_cash":2046.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 21029 BENIGN TUMOR REMOVAL CONTOUR OF FACIAL BONE","code_information":[{"code":"5101581","type":"CDM"},{"code":"0510","type":"RC"},{"code":"21029","type":"HCPCS"}],"standard_charges":[{"gross_charge":10215.0,"discounted_cash":6129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26750 CLSD DISTAL PHALANG FX WO MANIP, EA","code_information":[{"code":"5101590","type":"CDM"},{"code":"0510","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97007 SCALP COOLING HEAD MEASURE, CAP CALIBRATE, PT EDUCATE","code_information":[{"code":"5101596","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97007","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97008 SCALP COOLING HAIR PREP, CAP PLACE, THERAPY/PRECOOL, INTIAL PROC","code_information":[{"code":"5101597","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97008","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97009 SCALP COOLING CAP REMOVE & MONITOR EA 30 MIN, SEP PROC FROM INTIAL","code_information":[{"code":"5101598","type":"CDM"},{"code":"0510","type":"RC"},{"code":"97009","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 41115 EXCISION LINGUAL FRENUM FRENECTOMY","code_information":[{"code":"5101602","type":"CDM"},{"code":"0510","type":"RC"},{"code":"41115","type":"HCPCS"}],"standard_charges":[{"gross_charge":2363.0,"discounted_cash":1417.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 46250 HEMORRHOIDECTOMY EXTERNAL 2/> COLUMN/GROUP","code_information":[{"code":"5101603","type":"CDM"},{"code":"0510","type":"RC"},{"code":"46250","type":"HCPCS"}],"standard_charges":[{"gross_charge":5485.0,"discounted_cash":3291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRI TMJ JOINT(S)","code_information":[{"code":"6100002","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI TMJ JOINT(S)-FOLLOW UP","code_information":[{"code":"6100003","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC MRI ORBIT/FACE/NECK W/O CONTRAST","code_information":[{"code":"6100004","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":5425.0,"discounted_cash":3255.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5425.0,"discounted_cash":3255.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI ORBIT/FACE/NECK W/ CONTRAST","code_information":[{"code":"6100005","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70542","type":"HCPCS"}],"standard_charges":[{"gross_charge":5399.0,"discounted_cash":3239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5399.0,"discounted_cash":3239.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI ORBIT/FACE/NECK WO/W CONTRAST","code_information":[{"code":"6100006","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":5684.0,"discounted_cash":3410.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5684.0,"discounted_cash":3410.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI ORBIT/FACE/NECK WO/W CONTRAST, REDUC","code_information":[{"code":"6100007","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC MRA HEAD W/O CONTRAST","code_information":[{"code":"6100008","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA HEAD W/ CONTRAST","code_information":[{"code":"6100009","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":5179.0,"discounted_cash":3107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5179.0,"discounted_cash":3107.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA HEAD WO/W CONTRAST","code_information":[{"code":"6100010","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":5441.0,"discounted_cash":3264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5441.0,"discounted_cash":3264.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA NECK W/O CON","code_information":[{"code":"6100011","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA NECK W/ CONTRAST","code_information":[{"code":"6100012","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":5179.0,"discounted_cash":3107.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5179.0,"discounted_cash":3107.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA NECK WO/W CONTRAST","code_information":[{"code":"6100013","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":5441.0,"discounted_cash":3264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5441.0,"discounted_cash":3264.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI BRAIN INC STEM W/O CONTRAST","code_information":[{"code":"6100014","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70552 MRI BRAIN (INC BRAIN STEM) W CONTRAST","code_information":[{"code":"6100016","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":5562.0,"discounted_cash":3337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5562.0,"discounted_cash":3337.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70553 MRI BRAIN (INC BRAIN STEM) WO/W CONTRAST","code_information":[{"code":"6100018","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":6286.0,"discounted_cash":3771.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":6286.0,"discounted_cash":3771.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI,BRAIN,FUNC HC MRI INCLUDE W/O PHY","code_information":[{"code":"6100019","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70554","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRI CHEST W/O CONTRAST","code_information":[{"code":"6100020","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CHEST W/ CONTRAST","code_information":[{"code":"6100021","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71551","type":"HCPCS"}],"standard_charges":[{"gross_charge":6136.0,"discounted_cash":3681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":6136.0,"discounted_cash":3681.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CHEST WO/W CONTRAST","code_information":[{"code":"6100022","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6482.0,"discounted_cash":3889.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":6482.0,"discounted_cash":3889.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA  CHEST W/O CONTRAST","code_information":[{"code":"6100023","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA CHEST W/CONTRAST","code_information":[{"code":"6100024","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA CHEST W/O AND W/CONTRAST","code_information":[{"code":"6100025","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CERVICAL SPINE W/O CONTRAST","code_information":[{"code":"6100026","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":5315.0,"discounted_cash":3189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5315.0,"discounted_cash":3189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CERVICAL SPINE W/CONTRAST","code_information":[{"code":"6100027","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":5573.0,"discounted_cash":3343.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5573.0,"discounted_cash":3343.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI THORACIC SPINE W/O CONTRAST","code_information":[{"code":"6100028","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI THORACIC SPINE W/ CONTRAST","code_information":[{"code":"6100029","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":5573.0,"discounted_cash":3343.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5573.0,"discounted_cash":3343.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI LUMBAR SPINE W/O CONTRAST","code_information":[{"code":"6100030","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI LUMBAR SPINE W/ CONTRAST","code_information":[{"code":"6100031","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":5573.0,"discounted_cash":3343.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5573.0,"discounted_cash":3343.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CERV SPINE WO/W CONTRAST","code_information":[{"code":"6100032","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":5875.0,"discounted_cash":3525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5875.0,"discounted_cash":3525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI THORAC SPINE WO/W CONTRAST","code_information":[{"code":"6100033","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":5875.0,"discounted_cash":3525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5875.0,"discounted_cash":3525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI LUMBAR SPINE WO/W CONTRAST","code_information":[{"code":"6100034","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":5875.0,"discounted_cash":3525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5875.0,"discounted_cash":3525.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA SPINE CANAL W OR W/O CONTRAST","code_information":[{"code":"6100035","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":5569.0,"discounted_cash":3341.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5569.0,"discounted_cash":3341.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI PELVIS W/O CONTRAST","code_information":[{"code":"6100036","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI PELVIS W/ CONTRAST","code_information":[{"code":"6100037","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72196","type":"HCPCS"}],"standard_charges":[{"gross_charge":5362.0,"discounted_cash":3217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5362.0,"discounted_cash":3217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI PELVIS WO/W CON","code_information":[{"code":"6100038","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":6545.0,"discounted_cash":3927.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":6545.0,"discounted_cash":3927.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA PELVIS W/O CONTRAST","code_information":[{"code":"6100039","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA PELVIS W/O FOLLOW W/ CONTRAST","code_information":[{"code":"6100040","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA PELVIS WITH CONTRAST","code_information":[{"code":"6100041","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI UP EXTR NON JOINT W/O CONTRAST-LT","code_information":[{"code":"6100042","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTR NON JOINT W/O CONTRAST-RT","code_information":[{"code":"6100043","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTR NON JOINT W/O CONTRAST-BLT","code_information":[{"code":"6100044","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI UP EXTR NON JOINT W CONTRAST-LT","code_information":[{"code":"6100045","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTR NON JOINT W CONTRAST-RT","code_information":[{"code":"6100046","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTR NON JOINT W CONTRAST-BLT","code_information":[{"code":"6100047","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73219","type":"HCPCS"}],"standard_charges":[{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI UP EXTR, NON JOINT, WO/W CONTR-LT","code_information":[{"code":"6100048","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":3679.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6133.0,"discounted_cash":3679.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTR, NON JOINT, WO/W CONTR-RT","code_information":[{"code":"6100049","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":3679.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6133.0,"discounted_cash":3679.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTR, NON JOINT, WO/W CONTR-BLT","code_information":[{"code":"6100050","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":9200.0,"discounted_cash":5520.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":9200.0,"discounted_cash":5520.0,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73221 MRI UP EXTREM, ANY JOINT, W/O CONTRAST - LT","code_information":[{"code":"6100051","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73221 MRI UP EXTREM, ANY JOINT, W/O CONTRAST - RT","code_information":[{"code":"6100052","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73221 MRI UP EXTREM, ANY JOINT, W/O CONTRAST - BLT","code_information":[{"code":"6100053","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI UP EXTREM, ANY JOINT, W/CONTRAST-LT","code_information":[{"code":"6100054","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTREM, ANY JOINT, W/CONTRAST-RT","code_information":[{"code":"6100055","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTREM, ANY JOINT, W/CONTRAST-BLT","code_information":[{"code":"6100056","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI UP EXTREM, ANY JOINT, WO/W CONTR-LT","code_information":[{"code":"6100057","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":3679.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6133.0,"discounted_cash":3679.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTREM, ANY JOINT, WO/W CONTR-RT","code_information":[{"code":"6100058","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":3679.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6133.0,"discounted_cash":3679.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI UP EXTREM, ANY JOINT, WO/W CONTR-BLT","code_information":[{"code":"6100059","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":9200.0,"discounted_cash":5520.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":9200.0,"discounted_cash":5520.0,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRA UPPER EXTREM W OR W/O CONTRAST-LT","code_information":[{"code":"6100060","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA UPPER EXTREM W OR W/O CONTRAST-RT","code_information":[{"code":"6100061","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA UPPER EXTREM W OR W/O CONTRAST-BLT","code_information":[{"code":"6100062","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73718 MRI LOW EXTREM, NON JOINT, W/O CONTRAST - LT","code_information":[{"code":"6100063","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73718 MRI LOW EXTREM, NON JOINT, W/O CONTRAST - RT","code_information":[{"code":"6100064","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73718 MRI LOW EXTREM, NON JOINT, W/O CONTRAST - BLT","code_information":[{"code":"6100065","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI LOW EXTM, NON JOINT, W/ CONTRAST LT","code_information":[{"code":"6100066","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXTM, NON JOINT, W/ CONTRAST RT","code_information":[{"code":"6100067","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXTM, NON JOINT, W/ CONTRAST BLT","code_information":[{"code":"6100068","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73719","type":"HCPCS"}],"standard_charges":[{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI LOW EXT, NON JOINT, WO/W CONTRAST LT","code_information":[{"code":"6100069","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":3679.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6133.0,"discounted_cash":3679.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXT, NON JOINT, WO/W CONTRAST RT","code_information":[{"code":"6100070","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":6133.0,"discounted_cash":3679.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6133.0,"discounted_cash":3679.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXT, NON JOINT, WO/W CONTRAST BLT","code_information":[{"code":"6100071","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":9200.0,"discounted_cash":5520.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":9200.0,"discounted_cash":5520.0,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 73721 MRI LOW EXTREM, JOINT, W/O CONTRAST - LT","code_information":[{"code":"6100072","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73721 MRI LOW EXTREM, JOINT, W/O CONTRAST - RT","code_information":[{"code":"6100073","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":5157.0,"discounted_cash":3094.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5157.0,"discounted_cash":3094.2,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC 73721 MRI LOW EXTREM, JOINT, W/O CONTRAST - BLT","code_information":[{"code":"6100074","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7737.0,"discounted_cash":4642.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI LOW EXTREM, JOINT, W/ CONTRAST-LT","code_information":[{"code":"6100075","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXTREM, JOINT, W/ CONTRAST-RT","code_information":[{"code":"6100076","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5808.0,"discounted_cash":3484.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5808.0,"discounted_cash":3484.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXTREM, JOINT, W/ CONTRAST-BLT","code_information":[{"code":"6100077","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":8712.0,"discounted_cash":5227.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI LOW EXTREM, JOINT, WO/W CONTRAST-LT","code_information":[{"code":"6100078","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":6434.0,"discounted_cash":3860.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6434.0,"discounted_cash":3860.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXTREM, JOINT, WO/W CONTRAST-RT","code_information":[{"code":"6100079","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":6434.0,"discounted_cash":3860.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6434.0,"discounted_cash":3860.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI LOW EXTREM, JOINT, WO/W CONTRAST-BLT","code_information":[{"code":"6100080","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":9651.0,"discounted_cash":5790.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":9651.0,"discounted_cash":5790.6,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRA LOWER EXTREMITY W/ CONTRAST LT","code_information":[{"code":"6100081","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA LOWER EXTREMITY W/ CONTRAST RT","code_information":[{"code":"6100082","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA LOWER EXTREMITY W/ CONTRAST BLT","code_information":[{"code":"6100083","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRA LOWER EXTREMITY W/O AND W/CONTRAST LT","code_information":[{"code":"6100084","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA LOWER EXTREMITY W/O AND W/CONTRAST RT","code_information":[{"code":"6100085","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA LOWER EXTREMITY W/O AND W/CONTRAST BLT","code_information":[{"code":"6100086","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRA LOWER EXTREMITY W/O CONTRAST LT","code_information":[{"code":"6100087","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA LOWER EXTREMITY W/O CONTRAST RT","code_information":[{"code":"6100088","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRA LOWER EXTREMITY W/O CONTRAST BLT","code_information":[{"code":"6100089","type":"CDM"},{"code":"0616","type":"RC"},{"code":"73725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC MRI ABDOMEN W/O CONTRAST","code_information":[{"code":"6100090","type":"CDM"},{"code":"0610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI ABDOMEN W/ CONTRAST","code_information":[{"code":"6100091","type":"CDM"},{"code":"0610","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":5505.0,"discounted_cash":3303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5505.0,"discounted_cash":3303.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI ABDOMEN WO/W CONTRAST","code_information":[{"code":"6100092","type":"CDM"},{"code":"0610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":5801.0,"discounted_cash":3480.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5801.0,"discounted_cash":3480.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74185 / C8900  MRA ANGIOGRAPHY ABDOMEN W/CONTRAST","code_information":[{"code":"6100093","type":"CDM"},{"code":"0618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74185 / C8901 MRA ANGIOGRAPHY ABDOMEN W/O CONTRAST","code_information":[{"code":"6100094","type":"CDM"},{"code":"0618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 74185 / C8902 MRA ANGIOGRAPHY ABDOMEN W/O OR W/CONTRAST","code_information":[{"code":"6100095","type":"CDM"},{"code":"0618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5439.0,"discounted_cash":3263.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5439.0,"discounted_cash":3263.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CARDIAC FOR MORPH/FNCTION W/O CONTR","code_information":[{"code":"6100096","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75557","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CARDIAC W/STRESS IMAGIN W/O CONTRAST","code_information":[{"code":"6100098","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75559","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CARD  MORPH/FNCTION W/ W/O CONTRAST","code_information":[{"code":"6100100","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75561","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CARD  W/STRESS IMAGIN W/ W/O CONTRAST","code_information":[{"code":"6100102","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75563","type":"HCPCS"}],"standard_charges":[{"gross_charge":5114.0,"discounted_cash":3068.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5114.0,"discounted_cash":3068.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI 3D RECONSTRCT W/O INDEPEND WKS","code_information":[{"code":"6100104","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI 3D RECONSTRCT W/INDEPEND WKS","code_information":[{"code":"6100105","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI SPECTROSCOPY","code_information":[{"code":"6100106","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76390","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI UNLISTED HC MRI EXAM","code_information":[{"code":"6100107","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76498","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRI GUIDE NDLE PLACEMENT","code_information":[{"code":"6100108","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77021","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI GUIDE & MONTR VISCERAL TISS ABLATION","code_information":[{"code":"6100109","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77022","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI-BONE MARROW  BLOOD SUPPLY","code_information":[{"code":"6100122","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77084","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC CARD MRI IMAGI VELOCITY FLOW MAPPING","code_information":[{"code":"6100123","type":"CDM"},{"code":"0610","type":"RC"},{"code":"75565","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 70555 MRI,FUNCTW/ DOC TEST","code_information":[{"code":"6100124","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70555","type":"HCPCS"}],"standard_charges":[{"gross_charge":5201.0,"discounted_cash":3120.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRA SPINE CANAL W CONTRAST","code_information":[{"code":"6100125","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":5599.0,"discounted_cash":3359.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5599.0,"discounted_cash":3359.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA SPINE CANAL W/O CONTRAST","code_information":[{"code":"6100126","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":7121.0,"discounted_cash":4272.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":7121.0,"discounted_cash":4272.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA SPINE CANAL W/O /W CONTRAST","code_information":[{"code":"6100127","type":"CDM"},{"code":"0618","type":"RC"},{"code":"72159","type":"HCPCS"}],"standard_charges":[{"gross_charge":8261.0,"discounted_cash":4956.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":8261.0,"discounted_cash":4956.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W CONTRAST-LT","code_information":[{"code":"6100128","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5165.0,"discounted_cash":3099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5165.0,"discounted_cash":3099.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W CONTRAST-RT","code_information":[{"code":"6100129","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5165.0,"discounted_cash":3099.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5165.0,"discounted_cash":3099.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W CONTRAST-BLT","code_information":[{"code":"6100130","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":7748.0,"discounted_cash":4648.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":7748.0,"discounted_cash":4648.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W/O CONTRAST-LT","code_information":[{"code":"6100131","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W/O CONTRAST-RT","code_information":[{"code":"6100132","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W/O CONTRAST-BLT","code_information":[{"code":"6100133","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W/O / W CONTRAST-LT","code_information":[{"code":"6100134","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5426.0,"discounted_cash":3255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5426.0,"discounted_cash":3255.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W/O / W CONTRAST-RT","code_information":[{"code":"6100135","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5426.0,"discounted_cash":3255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5426.0,"discounted_cash":3255.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRA UPPER EXTREM W/O / W CONTRAST-BLT","code_information":[{"code":"6100136","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":8139.0,"discounted_cash":4883.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":8139.0,"discounted_cash":4883.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI CERV SPINE W/O CONTRAST-SNGL PLANE","code_information":[{"code":"6100137","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":5315.0,"discounted_cash":3189.0,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC MRI THOR SPINE W/O CONTRAST-SNGL PLANE","code_information":[{"code":"6100138","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC MRI LUMB SPINE W/O CONTRAST-SNGL PLANE","code_information":[{"code":"6100139","type":"CDM"},{"code":"0610","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC MRI BRAIN STEM W/O CONTRAST-SNGL PLANE","code_information":[{"code":"6100140","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC MRI FETAL  SINGLE OR 1ST GESTATION","code_information":[{"code":"6100141","type":"CDM"},{"code":"0610","type":"RC"},{"code":"74712","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRI FETAL  EA ADDL GESTATION","code_information":[{"code":"6100142","type":"CDM"},{"code":"0610","type":"RC"},{"code":"74713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST","code_information":[{"code":"6100143","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70559","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST","code_information":[{"code":"6100144","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70558","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST","code_information":[{"code":"6100145","type":"CDM"},{"code":"0610","type":"RC"},{"code":"70557","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C8903 MRI W/CONTRAST, BREAST, UNILAT-LT","code_information":[{"code":"6100146","type":"CDM"},{"code":"0610","type":"RC"},{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 77048 MRI BREAST; W/O & WITH CONTRAST & CAD IF PERFORMED, UNILAT-LT","code_information":[{"code":"6100147","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":6039.0,"discounted_cash":3623.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6039.0,"discounted_cash":3623.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI BREAST; W/O CONTRAST UNILAT-LT","code_information":[{"code":"6100148","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC C8903 MRI W/CONTRAST, BREAST, UNILAT-RT","code_information":[{"code":"6100150","type":"CDM"},{"code":"0610","type":"RC"},{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 77048 MRI BREAST; W/O & WITH CONTRAST & CAD IF PERFORMED, UNILAT-RT","code_information":[{"code":"6100151","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":6039.0,"discounted_cash":3623.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":6039.0,"discounted_cash":3623.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC MRI BREAST; W/O CONTRAST UNILAT-RT","code_information":[{"code":"6100152","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77046","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":5153.0,"discounted_cash":3091.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP | 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":"HC C8937 CAD BREAST MRI-ADD ON","code_information":[{"code":"6100153","type":"CDM"},{"code":"0610","type":"RC"},{"code":"C8937","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.006,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C8906 MRI W/CONTRAST, BREAST, BILAT","code_information":[{"code":"6100154","type":"CDM"},{"code":"0610","type":"RC"},{"code":"C8906","type":"HCPCS"}],"standard_charges":[{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77049 MRI BREAST W/O &WITH CONTRAST & CAD IF PERFORMED, BLT","code_information":[{"code":"6100155","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":9059.0,"discounted_cash":5435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":9059.0,"discounted_cash":5435.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC MRI BREAST W/O CONTRAST BLT","code_information":[{"code":"6100156","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":7729.0,"discounted_cash":4637.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76391 MAGNETIC RESONANCE ELASTOGRAPHY","code_information":[{"code":"6100157","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76391","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10011 FINE NEEDLE ASPIRATION BX W/MR GDN 1ST LESION","code_information":[{"code":"6100158","type":"CDM"},{"code":"0610","type":"RC"},{"code":"10011","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 10012 FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL","code_information":[{"code":"6100159","type":"CDM"},{"code":"0610","type":"RC"},{"code":"10012","type":"HCPCS"}],"standard_charges":[{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":5153.0,"discounted_cash":3091.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 76014 MR SAFETY IMPLANT &/ OR FOREIGN BODY ASSMT CLIN STAFF, 1ST 15 MIN","code_information":[{"code":"6100170","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76014","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76015 MR SAFETY IMPLANT &/ OR FOREIGN BODY ASSMT CLIN STAFF, EA ADD 30","code_information":[{"code":"6100171","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76015","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76016 MR SAFETY DETERMINATION BY PHYS OR OTHER QHP","code_information":[{"code":"6100172","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76016","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76017 MR SAFETY MED PHYSICS EXAM CUSTOM PLAN & PERFORMANCE MONITOR","code_information":[{"code":"6100173","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76017","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.0,"discounted_cash":456.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76018 MR SAFETY IMPLANT ELECTRONICS PREP UNDER SUPRVSN PHYS/QHP","code_information":[{"code":"6100174","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76018","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 76019 MR SAFETY IMPLANT POSITION &/OR IMMOBLIZE UNDER SUPVRVSN PHYS/QHP","code_information":[{"code":"6100175","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76019","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":112.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOCM <=149MG/ML IODINE, PER ML (CYSTO)","code_information":[{"code":"6210002","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9958","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOCM 200-249MG/ML IODINE, PER ML","code_information":[{"code":"6210003","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9960","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOCM 300-349MG/ML IODINE, PER ML","code_information":[{"code":"6210004","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9963","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LOCM 200-299 MG/ML IODINE PER ML","code_information":[{"code":"6210005","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9966","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LOCM 300-399 MG/ML IODINE PER ML","code_information":[{"code":"6210006","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GADOLINIUM MRI CONTRAST(NOS)/ML","code_information":[{"code":"6210010","type":"CDM"},{"code":"0636","type":"RC"},{"code":"A9579","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VISUALIZATION ADJUNCT LYMPHAZURIN PER ML","code_information":[{"code":"6210015","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9968","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ GADOTERIDOL, PER ML","code_information":[{"code":"6210022","type":"CDM"},{"code":"0636","type":"RC"},{"code":"A9576","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INJ GADOBENATE DIMEGLUMINE, PER ML","code_information":[{"code":"6210023","type":"CDM"},{"code":"0636","type":"RC"},{"code":"A9577","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RECOVERY, LEVEL 1","code_information":[{"code":"7100001","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1538.0,"discounted_cash":922.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RECOVERY, LEVEL 2","code_information":[{"code":"7100002","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1611.0,"discounted_cash":966.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RECOVERY, LEVEL 3","code_information":[{"code":"7100003","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1914.0,"discounted_cash":1148.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RECOVERY, LEVEL 4","code_information":[{"code":"7100004","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100004","type":"HCPCS"}],"standard_charges":[{"gross_charge":2279.0,"discounted_cash":1367.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RECOVERY, LEVEL 5","code_information":[{"code":"7100005","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2336.0,"discounted_cash":1401.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PACU PHASE II 0-30 MINUTES","code_information":[{"code":"7100006","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100006","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PACU PHASE II EA ADD'L 15 MINUTES","code_information":[{"code":"7100008","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100008","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC POST PROCEDURE RECOVERY EA HR","code_information":[{"code":"7100009","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100009","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CIRCUMCISION BY CLAMP/DEVICE W/ REGIONAL BLOCK","code_information":[{"code":"7200001","type":"CDM"},{"code":"0723","type":"RC"},{"code":"54150","type":"HCPCS"}],"standard_charges":[{"gross_charge":8676.0,"discounted_cash":5205.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC","code_information":[{"code":"7200002","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":548.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FETAL NON-STRESS TEST","code_information":[{"code":"7200004","type":"CDM"},{"code":"0920","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":622.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L&D EXTERNAL FETAL VERSION","code_information":[{"code":"7200006","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1990.0,"discounted_cash":1194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BILIRUBIN,TOTAL,TRANCUTANEOUS","code_information":[{"code":"7200007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":82.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":124.0,"discounted_cash":74.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC DELIVERY/BIRTHING ROOM RESUSCITATION","code_information":[{"code":"7200008","type":"CDM"},{"code":"0720","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":822.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIRTHING LEVEL I","code_information":[{"code":"7200011","type":"CDM"},{"code":"0720","type":"RC"},{"code":"7200011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2546.0,"discounted_cash":1527.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIRTHING LEVEL II","code_information":[{"code":"7200012","type":"CDM"},{"code":"0720","type":"RC"},{"code":"7200012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3814.0,"discounted_cash":2288.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L&D DELV RM (VAGINAL SINGLE BIRTH)","code_information":[{"code":"7200017","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":2196.0,"discounted_cash":1317.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L&D DELV RM (VAGINAL TWIN BIRTH)","code_information":[{"code":"7200018","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3016.0,"discounted_cash":1809.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L&D DELV RM (VAGINAL TRIPLE BIRTH)","code_information":[{"code":"7200019","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":5252.0,"discounted_cash":3151.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CERCLAGE CERVIX-DURING PREG-VAGINAL","code_information":[{"code":"7200022","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59320","type":"HCPCS"}],"standard_charges":[{"gross_charge":8452.0,"discounted_cash":5071.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C-SECTION W/O LABOR","code_information":[{"code":"7200023","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":7037.0,"discounted_cash":4222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC C-SECTION WITH LABOR","code_information":[{"code":"7200024","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":7037.0,"discounted_cash":4222.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CESAREAN-HYSTERECTOMY","code_information":[{"code":"7200025","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59525","type":"HCPCS"}],"standard_charges":[{"gross_charge":9061.0,"discounted_cash":5436.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DELIVERY ROOM/SURG PROC","code_information":[{"code":"7200030","type":"CDM"},{"code":"0722","type":"RC"},{"code":"7200030","type":"HCPCS"}],"standard_charges":[{"gross_charge":1496.0,"discounted_cash":897.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEWBORN,RESUSCITATION","code_information":[{"code":"7200031","type":"CDM"},{"code":"0720","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":822.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CIRCUMCISION,NO CLAMP/DEVICE, NEWBORN","code_information":[{"code":"7200035","type":"CDM"},{"code":"0723","type":"RC"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":10401.0,"discounted_cash":6240.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BIRTHING LEVEL III","code_information":[{"code":"7200052","type":"CDM"},{"code":"0720","type":"RC"},{"code":"7200052","type":"HCPCS"}],"standard_charges":[{"gross_charge":8916.0,"discounted_cash":5349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ECG 12 LEAD, TRACING ONLY","code_information":[{"code":"7300001","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RHYTHM ECG 1-3 LEAD TRACING ONLY","code_information":[{"code":"7300002","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93041","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":341.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SIGNAL-AVERAGED ECG (SAECG)-FAC","code_information":[{"code":"7300005","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93278","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93270 EVENT RECORDER, 30 DAY, RECORDING","code_information":[{"code":"7300006","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93271 EVENT REC, PRESYM, 30 DAY, TRANS & ANALY","code_information":[{"code":"7300007","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93225 HOLTER MONITOR UP TO 48 HRS VIS SUPERIMP REC","code_information":[{"code":"7300012","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93226 HOLTER MONITOR UP TO 48 HRS VIS SUPERIMP SCN/RPT","code_information":[{"code":"7300013","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93242 EXTERNAL ECG REC>48HR<7DAY RECORDING","code_information":[{"code":"7300018","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93243 EXTERNAL ECG REC>48HR<7DAY SCANNING ALYS W/REPORT","code_information":[{"code":"7300019","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93243","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93246 EXTERNAL ECG REC>7D<15DAY RECORDING","code_information":[{"code":"7300020","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93246","type":"HCPCS"}],"standard_charges":[{"gross_charge":624.0,"discounted_cash":374.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93247 EXTERNAL ECG REC>7D<15DAY SCANNING ALYS W/REPORT","code_information":[{"code":"7300021","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95805 MULTIPLE SLEEP LATENCY TEST (MSLT)","code_information":[{"code":"7400001","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":6591.0,"discounted_cash":3954.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95805 MULTIPLE SLEEP LATENCY TEST-REDUCED","code_information":[{"code":"7400002","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":6591.0,"discounted_cash":3954.6,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 95806 SLEEP STUDY, UNATTENDED BY TECH","code_information":[{"code":"7400003","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95806 SLEEP STUDY, UNATTEND BY TECH-REDUCE","code_information":[{"code":"7400004","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95806","type":"HCPCS"}],"standard_charges":[{"gross_charge":1185.0,"discounted_cash":711.0,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 95807 SLEEP STUDY, ATTENDED BY TECH","code_information":[{"code":"7400005","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95807","type":"HCPCS"}],"standard_charges":[{"gross_charge":6630.0,"discounted_cash":3978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95807 SLEEP STUDY, ATTENDED BY TECH-REDUCED","code_information":[{"code":"7400006","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95807","type":"HCPCS"}],"standard_charges":[{"gross_charge":6630.0,"discounted_cash":3978.0,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 95808 POLYSOMNOGRAPHY, 1-3 ADDL PARAM","code_information":[{"code":"7400007","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95808","type":"HCPCS"}],"standard_charges":[{"gross_charge":7154.0,"discounted_cash":4292.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95808  POLYSOMNOGRAPH, 1-3 ADD PARAM-REDUCE","code_information":[{"code":"7400008","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95808","type":"HCPCS"}],"standard_charges":[{"gross_charge":7154.0,"discounted_cash":4292.4,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 95810 POLYSOMNOGRAPH, 4 OR > PARAM-REDUC","code_information":[{"code":"7400009","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":8475.0,"discounted_cash":5085.0,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 95810 POLYSOMNOGRAPHY, 4 OR > PARAM","code_information":[{"code":"7400010","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":8475.0,"discounted_cash":5085.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95811  POLYSOMNOGRAPH W/ CPAP-REDUCED","code_information":[{"code":"7400011","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":8938.0,"discounted_cash":5362.8,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 95811 POLYSOMNOGRAPH W/ CPAP","code_information":[{"code":"7400012","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":8938.0,"discounted_cash":5362.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95812 EEG EXTENDED MONITORING, 41-60 MINUTES","code_information":[{"code":"7400013","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95812","type":"HCPCS"}],"standard_charges":[{"gross_charge":2059.0,"discounted_cash":1235.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95813 EEG EXTENDED MONITORING, 61-119 MINUTES","code_information":[{"code":"7400014","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":2580.0,"discounted_cash":1548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95816 EEG AWAKE AND DROWSY","code_information":[{"code":"7400016","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":2100.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EEG AWAKE AND ASLEEP-REDUCED","code_information":[{"code":"7400017","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2160.0,"discounted_cash":1296.0,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC 95819 EEG AWAKE AND ASLEEP","code_information":[{"code":"7400019","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2160.0,"discounted_cash":1296.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EEG SLEEP ONLY","code_information":[{"code":"7400021","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2084.0,"discounted_cash":1250.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EEG CEREBRAL DEATH EVAL ONLY","code_information":[{"code":"7400022","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":2677.0,"discounted_cash":1606.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ELECTROCORTICOGRAM AT SURGERY","code_information":[{"code":"7400025","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95829","type":"HCPCS"}],"standard_charges":[{"gross_charge":5851.0,"discounted_cash":3510.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95930 VISUAL EVOKED POTENT,CHCKRBRD/FLASH EXC GLAUCOMA W/INTERP","code_information":[{"code":"7400028","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":999.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95930 VISUAL EVOKED POTENT,CHCKRBRD/FLASH EXC GLAUCOMA W/INTERP","code_information":[{"code":"7400029","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1989.0,"discounted_cash":1193.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EEG DURING NON-INTRACRANIAL SURGERY","code_information":[{"code":"7400036","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95955","type":"HCPCS"}],"standard_charges":[{"gross_charge":1964.0,"discounted_cash":1178.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EEG DIGITAL ANALYSIS  EPILEPTIC SPIKES","code_information":[{"code":"7400037","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95957","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":487.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FUNCT CORT/SUBCORT MAPPING,1ST HOUR-SURG","code_information":[{"code":"7400040","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95961","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95803 ACTIGRAPHY TEST W/ RECRD,ANALY,INTERP, REPORT MINI 72HRS","code_information":[{"code":"7400046","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95803","type":"HCPCS"}],"standard_charges":[{"gross_charge":1132.0,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0399 HOME SLEEP STUDY UNATTEND TYPE III MIN 4 CHAN","code_information":[{"code":"7400048","type":"CDM"},{"code":"0740","type":"RC"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":1059.0,"discounted_cash":635.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CONT INTRAOP NEUROPHYS MONITOR 1:1 IN THE OR EA 15 MIN","code_information":[{"code":"7400049","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95940","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95801 SLEEP STUDY UNATTENDED MIN HR,O2 SAT, RESP ANLYS","code_information":[{"code":"7400055","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95801","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95700 EEG CONT REC INCL VIDEO, TECH, MIN 8 CHNLS, SETUP, PT ED, TAKEDOWN F2F","code_information":[{"code":"7400057","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.0,"discounted_cash":778.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95705 EEG W/O VIDEO, TECH, 2-12 HRS, UNMONITORED","code_information":[{"code":"7400058","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95705","type":"HCPCS"}],"standard_charges":[{"gross_charge":7139.0,"discounted_cash":4283.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95706 EEG W/O VIDEO, TECH, 2-12 HRS, INTERMITTENT MONITORING","code_information":[{"code":"7400059","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95706","type":"HCPCS"}],"standard_charges":[{"gross_charge":7139.0,"discounted_cash":4283.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95707 EEG W/O VIDEO, TECH, 2-12 HRS, CONTINUOUS MONITORING","code_information":[{"code":"7400060","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95707","type":"HCPCS"}],"standard_charges":[{"gross_charge":7139.0,"discounted_cash":4283.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95708 EEG W/O VIDEO, TECH, 12-26 HRS, UNMONITORED","code_information":[{"code":"7400061","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95708","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":4563.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95709 EEG W/O VIDEO, TECH, 12-26 HRS, INTERMITTENT MONITORING","code_information":[{"code":"7400062","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95709","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":4563.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95710 EEG W/O VIDEO, TECH, 12-26 HRS, CONTINUOUS MONITORING","code_information":[{"code":"7400063","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95710","type":"HCPCS"}],"standard_charges":[{"gross_charge":7606.0,"discounted_cash":4563.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95711 EEG W/VIDEO, TECH, 2-12 HRS, UNMONITORED","code_information":[{"code":"7400064","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95711","type":"HCPCS"}],"standard_charges":[{"gross_charge":7139.0,"discounted_cash":4283.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95712 EEG W/VIDEO, TECH, 2-12 HRS, INTERMITTENT MONITORING","code_information":[{"code":"7400065","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95712","type":"HCPCS"}],"standard_charges":[{"gross_charge":7139.0,"discounted_cash":4283.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95713 EEG W/VIDEO, TECH, 2-12 HRS, CONTINUOUS MONITORING","code_information":[{"code":"7400066","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6343.0,"discounted_cash":3805.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95714 EEG W/VIDEO, TECH, 12-26 HRS, UNMONITORED","code_information":[{"code":"7400067","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95714","type":"HCPCS"}],"standard_charges":[{"gross_charge":8397.0,"discounted_cash":5038.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95715 EEG W/VIDEO, TECH, 12-26 HRS, INTERMITTENT MONITORING","code_information":[{"code":"7400068","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95715","type":"HCPCS"}],"standard_charges":[{"gross_charge":8397.0,"discounted_cash":5038.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95716 EEG W/VIDEO, TECH, 12-26 HRS, CONTINUOUS MONITORING","code_information":[{"code":"7400069","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":7460.0,"discounted_cash":4476.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GI PROCEDURE ROOM 0-15 MINUTES LEVEL 1","code_information":[{"code":"7500001","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1462.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GI PROCEDURE ROOM 0-15 MINUTES LEVEL II","code_information":[{"code":"7500002","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.0,"discounted_cash":1514.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GI PROCEDURE ROOM 0-15 MINUTES LEVEL III","code_information":[{"code":"7500003","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500003","type":"HCPCS"}],"standard_charges":[{"gross_charge":2828.0,"discounted_cash":1696.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GI PROCEDURE ROOM EA ADD'L 15 MIN LEVEL I","code_information":[{"code":"7500004","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500004","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.0,"discounted_cash":924.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GI PROCEDURE ROOM EA ADD'L 15 MIN L II","code_information":[{"code":"7500005","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.0,"discounted_cash":996.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GI PROCEDURE ROOM EA ADD'L 15 MIN L III","code_information":[{"code":"7500006","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.0,"discounted_cash":1033.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCHOSCOPY 0-15 MINUTES LEVEL II","code_information":[{"code":"7500007","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":2401.0,"discounted_cash":1440.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCHOSCOPY EA ADD'L 15 MINUTES LEVEL II","code_information":[{"code":"7500008","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500008","type":"HCPCS"}],"standard_charges":[{"gross_charge":1585.0,"discounted_cash":951.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCHOSCOPY 0-15 MINUTES LEVEL III","code_information":[{"code":"7500009","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500009","type":"HCPCS"}],"standard_charges":[{"gross_charge":2694.0,"discounted_cash":1616.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BRONCHOSCOPY EA ADD'L 15 MINUTES LEVEL III","code_information":[{"code":"7500010","type":"CDM"},{"code":"0750","type":"RC"},{"code":"7500010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1639.0,"discounted_cash":983.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64415 INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS, SINGLE","code_information":[{"code":"7610007","type":"CDM"},{"code":"0761","type":"RC"},{"code":"64415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":989.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64447 INJECTION, ANESTHETIC AGENT; FEMORAL NERVE, SINGLE","code_information":[{"code":"7610008","type":"CDM"},{"code":"0761","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":1432.0,"discounted_cash":859.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64450 INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH","code_information":[{"code":"7610009","type":"CDM"},{"code":"0761","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.0,"discounted_cash":717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64417 INJ ANES AXILLARY NERVE","code_information":[{"code":"7610010","type":"CDM"},{"code":"0761","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2591.0,"discounted_cash":1554.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62320 EPIDURAL NJX, CERV/THORACIC W/O IMAGING","code_information":[{"code":"7610011","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":5956.0,"discounted_cash":3573.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62321 EPIDURAL NJX,  CERV/THORACIC, WITH IMAGING","code_information":[{"code":"7610012","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":8277.0,"discounted_cash":4966.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62322 EPIDURAL NJX, LUMBAR/SACRAL W/O IMAGING","code_information":[{"code":"7610013","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":2570.0,"discounted_cash":1542.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62323 EPIDURAL NJX, LUMBAR/SACRAL WITH IMAGING","code_information":[{"code":"7610014","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":3225.0,"discounted_cash":1935.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62324 EPIDURAL INFUSION, CERVICAL OR THORACIC - NO IMAGING","code_information":[{"code":"7610015","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":5670.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62325 EPIDURAL INFUSION, CERVICAL OR THORACIC - WITH IMAGING","code_information":[{"code":"7610016","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62325","type":"HCPCS"}],"standard_charges":[{"gross_charge":9061.0,"discounted_cash":5436.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62326 EPIDURAL INFUSION, LUMBAR/SACRAL - NO IMAGING","code_information":[{"code":"7610017","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62326","type":"HCPCS"}],"standard_charges":[{"gross_charge":5670.0,"discounted_cash":3402.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62327 EPIDURAL INFUSION, LUMBAR/SACRAL - WITH IMAGING","code_information":[{"code":"7610018","type":"CDM"},{"code":"0761","type":"RC"},{"code":"62327","type":"HCPCS"}],"standard_charges":[{"gross_charge":9061.0,"discounted_cash":5436.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL OBSERVATION, PER HOUR","code_information":[{"code":"7620002","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DIRECT ADMISSION OBSERVATION CARE","code_information":[{"code":"7620003","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":386.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - CARDIOLOGY","code_information":[{"code":"7620005","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - DIGESTIVE (COLONOSCOPY/EGD)","code_information":[{"code":"7620006","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - DIAGNOSTIC IMAGING","code_information":[{"code":"7620007","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - CARDIAC CATH","code_information":[{"code":"7620008","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - DIALYSIS","code_information":[{"code":"7620009","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - BLOOD TRANSFUSION","code_information":[{"code":"7620010","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - PROCEDURAL","code_information":[{"code":"7620011","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - IV THERAPY","code_information":[{"code":"7620012","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - REHAB","code_information":[{"code":"7620013","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - ANGIOGRAM","code_information":[{"code":"7620014","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OBSERVATION CARVE-OUT - SURGICAL","code_information":[{"code":"7620015","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ESWL-UNILATERAL STONE(S)","code_information":[{"code":"7900001","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"gross_charge":36691.0,"discounted_cash":22014.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ESWL-BILATERAL STONES","code_information":[{"code":"7900002","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"gross_charge":47328.0,"discounted_cash":28396.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ESWL W/CYSTO-UNILATERAL STONES","code_information":[{"code":"7900003","type":"CDM"},{"code":"0790","type":"RC"},{"code":"7900003","type":"HCPCS"}],"standard_charges":[{"gross_charge":38166.0,"discounted_cash":22899.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ESWL W/CYSTO-BILATERAL STONES","code_information":[{"code":"7900004","type":"CDM"},{"code":"0790","type":"RC"},{"code":"7900004","type":"HCPCS"}],"standard_charges":[{"gross_charge":54528.0,"discounted_cash":32716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90935 IP HEMODIALYSIS TRMT EA","code_information":[{"code":"8010001","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1567.0,"discounted_cash":940.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90945 CAPD - CONTINUOUS AMBULATORY PERITONEAL DIALYSIS","code_information":[{"code":"8010003","type":"CDM"},{"code":"0803","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90945 CCPD - IP CONT CYCLING PERITONEAL DIALYSIS","code_information":[{"code":"8010004","type":"CDM"},{"code":"0804","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1196.0,"discounted_cash":717.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90945 CRRT - CONTINUOUS RENAL REPLACEMENT THERAPY","code_information":[{"code":"8010009","type":"CDM"},{"code":"0809","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":790.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90935 / G0257 OP HEMODIALYSIS TRMT EA","code_information":[{"code":"8010029","type":"CDM"},{"code":"0829","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1863.0,"discounted_cash":1117.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90945 OP CCPD - CONT CYCLING PERITONEAL DIALYSIS","code_information":[{"code":"8010030","type":"CDM"},{"code":"0830","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.0,"discounted_cash":636.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION","code_information":[{"code":"9000043","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90792 PSYCHIATRIC DX EVAL W/ MEDICAL SERVICES","code_information":[{"code":"9000045","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90792","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":257.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BEHAVIORAL COUNSELING FOR OBESITY, IND PER 15 MIN","code_information":[{"code":"9000074","type":"CDM"},{"code":"0900","type":"RC"},{"code":"G0447","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90832 PSYCHOTHERAPY 30 MIN W/PT","code_information":[{"code":"9000079","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90832 PSYCHOTHERAPY 30 MIN W/PT","code_information":[{"code":"9000080","type":"CDM"},{"code":"0911","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90834 PSYCHOTHERAPY 45 MIN W/PT","code_information":[{"code":"9000083","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90834 PSYCHOTHERAPY 45 MIN W/PT","code_information":[{"code":"9000084","type":"CDM"},{"code":"0911","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90837 PSYCHOTHERAPY 60 MIN W/PT","code_information":[{"code":"9000087","type":"CDM"},{"code":"0911","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90837 PSYCHOTHERAPY 60 MIN W/PT","code_information":[{"code":"9000088","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 FAMILY PSYCHOTHERAPY W/O PT,50 MIN","code_information":[{"code":"9000091","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 FAMILY PSYCHOTHERAPY W/O PT,50 MIN-B","code_information":[{"code":"9000092","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 FAMILY PSYCHOTHERAPY W/O PT/FAC,50 MIN","code_information":[{"code":"9000093","type":"CDM"},{"code":"0911","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90847 FAMILY PSYCHOTHERAPY W/ PT,50 MIN","code_information":[{"code":"9000094","type":"CDM"},{"code":"0916","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90847 FAMILY PSYCHOTHERAPY W/ PT 50 MIN","code_information":[{"code":"9000095","type":"CDM"},{"code":"0900","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97129 THERAPEUTIC INTERVENTION FOCUS CONGNITIVE FUNCTION 1ST 15 MINUTES","code_information":[{"code":"9000099","type":"CDM"},{"code":"0900","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":105.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":157.0,"discounted_cash":94.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 97130 THERAPEUTIC INTERVENTION FOCUS CONGNITIVE FUNCTION EA ADDL 15 MINUTES","code_information":[{"code":"9000100","type":"CDM"},{"code":"0900","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"},{"gross_charge":55.0,"discounted_cash":33.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 90832 IOP PSYCHOTHERAPY 30 MIN W/PT","code_information":[{"code":"9120005","type":"CDM"},{"code":"0912","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90834 IOP PSYCHOTHERAPY 45 MIN W/PT","code_information":[{"code":"9120006","type":"CDM"},{"code":"0912","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 IOP FAMILY PSYCHOTHERAPY W/O PT,50 MIN","code_information":[{"code":"9120007","type":"CDM"},{"code":"0912","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90847 IOP FAMILY PSYCHOTHERAPY WITH PT,50 MIN","code_information":[{"code":"9120008","type":"CDM"},{"code":"0912","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90832 PHP PSYCHOTHERAPY 30 MIN W/PT","code_information":[{"code":"9130008","type":"CDM"},{"code":"0913","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90834 PHP PSYCHOTHERAPY 45 MIN W/PT","code_information":[{"code":"9130009","type":"CDM"},{"code":"0913","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 PHP FAMILY PSYCHOTHERAPY W/O PT,50 MIN","code_information":[{"code":"9130010","type":"CDM"},{"code":"0913","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90847 PHP FAMILY PSYCHOTHERAPY WITH PT,50 MIN","code_information":[{"code":"9130011","type":"CDM"},{"code":"0913","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90832 PSYCHOTHERAPY 30 MIN W/PT","code_information":[{"code":"9140021","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90834 PSYCHOTHERAPY 45 MIN W/PT","code_information":[{"code":"9140024","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90837 PSYCHOTHERAPY 60 MIN W/PT","code_information":[{"code":"9140026","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90838 PSYCHOTHERAPY 60 MIN W/PT W/E&M","code_information":[{"code":"9140027","type":"CDM"},{"code":"0914","type":"RC"},{"code":"90838","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.0,"discounted_cash":271.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 PSYCHOTHERAPY FAMILY W/O PT,50 MIN","code_information":[{"code":"9140028","type":"CDM"},{"code":"0916","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96138 PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN","code_information":[{"code":"9180018","type":"CDM"},{"code":"0918","type":"RC"},{"code":"96138","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":251.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92235 FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R-RT","code_information":[{"code":"9200003","type":"CDM"},{"code":"0920","type":"RC"},{"code":"92235","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 92235 FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R-LT","code_information":[{"code":"9200004","type":"CDM"},{"code":"0920","type":"RC"},{"code":"92235","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.0,"discounted_cash":563.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 92235 FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R-BLT","code_information":[{"code":"9200005","type":"CDM"},{"code":"0920","type":"RC"},{"code":"92235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":844.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 93288 EVAL SGL,DUAL,MULT,LDLSS PACMKR IN PERSON","code_information":[{"code":"9200006","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX EXTRACRN ARTERIES COMP BILAT-FAC","code_information":[{"code":"9200011","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":1609.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93882 DUPLEX EXTRACRN ARTER UNILAT/LIMITED-RT","code_information":[{"code":"9200012","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1736.0,"discounted_cash":1041.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 93882 DUPLEX EXTRACRN ARTER UNILAT/LIMITED-LT","code_information":[{"code":"9200013","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1736.0,"discounted_cash":1041.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 93882 DUPLEX EXTRACRN ARTER UNILAT/LIMITED","code_information":[{"code":"9200014","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1736.0,"discounted_cash":1041.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCRN DOPPLER INTRACRN ARTER COMP-921","code_information":[{"code":"9200015","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93886","type":"HCPCS"}],"standard_charges":[{"gross_charge":2528.0,"discounted_cash":1516.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCRN DOPPLER INTRACRN ARTER LTD-921","code_information":[{"code":"9200016","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93888","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.0,"discounted_cash":1011.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93922 PHY STDY UP/LOW EXTREM ART SNGL BILAT","code_information":[{"code":"9200017","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1173.0,"discounted_cash":703.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93923 PHY STDY UP/LOW EXT MULT BLT, LEV I-FAC","code_information":[{"code":"9200018","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1337.0,"discounted_cash":802.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PHY STDY UP/LOW EXT MULT BLT, LEV II-FAC","code_information":[{"code":"9200019","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1002.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PHY STDY LOW EXTEM ART REST/STRES BILAT","code_information":[{"code":"9200020","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.0,"discounted_cash":1003.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PHY STDY LOW EXTEM ART REST/STRES LIMITD","code_information":[{"code":"9200021","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.0,"discounted_cash":754.2,"setting":"both","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"HC DUPLEX LOW EXTREM ARTER/BPG COMP BILAT","code_information":[{"code":"9200022","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":1344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX LOW EXTREM ARTER/BPG UNIL/LTD-RT","code_information":[{"code":"9200023","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.0,"discounted_cash":898.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DUPLEX LOW EXTREM ARTER/BPG UNIL/LTD-LT","code_information":[{"code":"9200024","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.0,"discounted_cash":898.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DUPLEX LOW EXTREM ARTER/BPG UNIL/LTD","code_information":[{"code":"9200025","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1696.0,"discounted_cash":1017.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX UP EXTREM ARTER/BPG  COMP BILAT","code_information":[{"code":"9200026","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX UP EXT ARTER/BPG COMP BLT LEVEL II","code_information":[{"code":"9200027","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":3099.0,"discounted_cash":1859.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX UP EXTREM ARTER/BPG UNIL/LTD-RT","code_information":[{"code":"9200028","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":994.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DUPLEX UP EXTREM ARTER/BPG UNIL/LTD-LT","code_information":[{"code":"9200029","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":994.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DUPLEX UP EXTREM ARTER/BPG UNIL/LTD","code_information":[{"code":"9200030","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":994.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93970 DUPLEX EXTREM VEINS COMPLETE BILAT","code_information":[{"code":"9200032","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2474.0,"discounted_cash":1484.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93971 DUPLEX EXTREM VEINS UNILAT/LIMITED-RT","code_information":[{"code":"9200033","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":989.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 93971 DUPLEX EXTREM VEINS UNILAT/LIMITED-LT","code_information":[{"code":"9200034","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":989.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 93971 DUPLEX EXTREMITIES VEINS UNILAT/LIMITED","code_information":[{"code":"9200035","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":1036.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX ART INFL/VEN OUTFL ABD/PELV/SCR COMP","code_information":[{"code":"9200036","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":2232.0,"discounted_cash":1339.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93976 ABD ART/VEN DUP/ LIMITED STUDY","code_information":[{"code":"9200037","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1465.0,"discounted_cash":879.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX AORTA, IVC, ILIAC VSC,BPG COMPLETE","code_information":[{"code":"9200038","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93978","type":"HCPCS"}],"standard_charges":[{"gross_charge":2106.0,"discounted_cash":1263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX AORTA, IVC, ILIAC VSC, BPG UNIL/LTD","code_information":[{"code":"9200039","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93979","type":"HCPCS"}],"standard_charges":[{"gross_charge":1539.0,"discounted_cash":923.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX ART INFL/VEN OUTFL PENILE COMP","code_information":[{"code":"9200040","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93980","type":"HCPCS"}],"standard_charges":[{"gross_charge":1946.0,"discounted_cash":1167.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX ART INFL/VEN OUTFL PENILE F/U LTD","code_information":[{"code":"9200041","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93981","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":587.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DUPLEX HEMODIALYSIS ACCESS","code_information":[{"code":"9200042","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":687.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EMG-ANAL/URETHRAL SPINCTER OTHER THAN NEEDLE","code_information":[{"code":"9200044","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51784","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COMPLEX CYSTOMETROGRAM W/URETHRAL PRESSURE STUDIES","code_information":[{"code":"9200047","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51727","type":"HCPCS"}],"standard_charges":[{"gross_charge":2140.0,"discounted_cash":1284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COMPLEX CYSTOMETROGRAM PRESSURE & VOIDING STUDY","code_information":[{"code":"9200049","type":"CDM"},{"code":"0920","type":"RC"},{"code":"51729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2140.0,"discounted_cash":1284.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94726 PLETHYSMOGRAPHY LUNG VOL/AIRWAY RESIST","code_information":[{"code":"9200052","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GAS DILUT OR WASHOUT FOR LUNG VOLUME","code_information":[{"code":"9200053","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":678.0,"discounted_cash":406.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94729 DIFFUSING CAPACITY","code_information":[{"code":"9200055","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":675.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FACIAL NERVE FUNCTION STUDIES","code_information":[{"code":"9200058","type":"CDM"},{"code":"0920","type":"RC"},{"code":"92516","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":461.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ELECT ANLYS IMPLNTD PUMP WO REPROG/REFILL","code_information":[{"code":"9200059","type":"CDM"},{"code":"0920","type":"RC"},{"code":"62367","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":407.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94780 CAR SEAT/BED AIRWAY TESTING CONTINUOUS; 60 MIN, <12MNTHS","code_information":[{"code":"9200066","type":"CDM"},{"code":"0920","type":"RC"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":100.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 94781 CAR SEAT/BED AIRWAY TESTING CONT; EA ADDTL 30 MIN, <12MNTHS","code_information":[{"code":"9200067","type":"CDM"},{"code":"0920","type":"RC"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":100.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93892 TRANSCRAN EMBOLI DETECT W/OUT INJ","code_information":[{"code":"9200068","type":"CDM"},{"code":"0920","type":"RC"},{"code":"93892","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.0,"discounted_cash":568.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 93893 TRANSCRAN EMBOLI DETECT WITH INJ","code_information":[{"code":"9200069","type":"CDM"},{"code":"0920","type":"RC"},{"code":"93893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.0,"discounted_cash":611.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95004 PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS","code_information":[{"code":"9200072","type":"CDM"},{"code":"0924","type":"RC"},{"code":"95004","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":57.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 51785 EMG NEEDLE ANAL OR URETHRAL SPHINC-SURG","code_information":[{"code":"9220001","type":"CDM"},{"code":"0922","type":"RC"},{"code":"51785","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"discounted_cash":576.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95860 EMG 1 EXT W/ OR W/O PARASPINAL","code_information":[{"code":"9220002","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":436.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95861 EMG 2 EXT W/ OR W/O PARASPINAL","code_information":[{"code":"9220005","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":1082.0,"discounted_cash":649.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95863 EMG 3 EXT W/ OR W/O PARASPINAL","code_information":[{"code":"9220006","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95863","type":"HCPCS"}],"standard_charges":[{"gross_charge":1350.0,"discounted_cash":810.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95864 EMG 4 EXT W/ OR W/O PARASPINAL","code_information":[{"code":"9220009","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95864","type":"HCPCS"}],"standard_charges":[{"gross_charge":1752.0,"discounted_cash":1051.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95865 EMG NEEDLE  LARYNX-SURG","code_information":[{"code":"9220010","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95865","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95867 EMG CRANIAL NERVE MUSCLES, UNIL-RT-SURG","code_information":[{"code":"9220011","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 95867 EMG CRANIAL NERVE MUSCLES, UNIL-LT-SURG","code_information":[{"code":"9220012","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.0,"discounted_cash":511.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 95868 EMG CRANIAL NERVE MUSCLE, BIL-SURG","code_information":[{"code":"9220013","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.0,"discounted_cash":766.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95870 EMG LIMITED 1 EXT/NON-LIMB MUSCLES","code_information":[{"code":"9220014","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95870","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95874 EMG NEEDLE GUIDE NERVE DESTR","code_information":[{"code":"9220016","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95874","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95925 SOMATOSENSORY EVOKED POTN UP EXTRMY","code_information":[{"code":"9220019","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1141.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95925 SOMATOSENS EVOKED POTN UP EXTR-SURG","code_information":[{"code":"9220020","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95925","type":"HCPCS"}],"standard_charges":[{"gross_charge":3410.0,"discounted_cash":2046.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95926 SOMATOSENSORY EVOKED POTN LOW EXTRMTY","code_information":[{"code":"9220021","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1141.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95926 SOMATOSENS EVOKED POTN LOW EXT-SURG","code_information":[{"code":"9220022","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1902.0,"discounted_cash":1141.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95927 SOMATOSENSORY EVOKED POTN TRNK/HEAD-SUR","code_information":[{"code":"9220023","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95927","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.0,"discounted_cash":857.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95928 TRNSCRNL CNTLR MOTOR EVOKED POTN UP EXT SURG","code_information":[{"code":"9220024","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95928","type":"HCPCS"}],"standard_charges":[{"gross_charge":1068.0,"discounted_cash":640.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95929 TRNSCRNL CNTLR MOTOR EVOKED POTN LOW EXT SURG","code_information":[{"code":"9220025","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95929","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":499.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95930 VISUAL EVOKED POTENT,CHCKRBRD/FLASH EXC GLAUCOMA W/INTERP","code_information":[{"code":"9220027","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":999.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95937 NEUROMUSCULAR JUNCTION TEST EA NRV","code_information":[{"code":"9220035","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95938 SSEP EVOKED POTENT STUDY UPPER & LOWER LIMBS-SURG","code_information":[{"code":"9220042","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":5304.0,"discounted_cash":3182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95939 TCMEP MOTOR EVOKED STUDY UPPER & LOWER LIMBS-SURG","code_information":[{"code":"9220043","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95939","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.0,"discounted_cash":996.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95938 SSEP EVOKED POTENT STUDY UPPER & LOWER LIMBS","code_information":[{"code":"9220044","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.0,"discounted_cash":2276.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95939 TCMEP MOTOR EVOKED STUDY UPPER & LOWER LIMBS","code_information":[{"code":"9220045","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95939","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.0,"discounted_cash":996.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95885 NDL EMG, EA EXTREM DONE W/NERVE COND;LTD","code_information":[{"code":"9220046","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":276.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95886 NDL EMG, EA EXTREM DONE W/NERVE COND;COMPLETE","code_information":[{"code":"9220047","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":461.0,"discounted_cash":276.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95887 NDL EMG, NON-EXT MUSC DONE W/NERVE CONDUCTION","code_information":[{"code":"9220048","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95907 NERVE CONDUCTION STUDIES 1-2 STUDIES","code_information":[{"code":"9220049","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95907","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.0,"discounted_cash":433.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95908 NERVE CONDUCTION STUDIES 3-4 STUDIES","code_information":[{"code":"9220050","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95908","type":"HCPCS"}],"standard_charges":[{"gross_charge":1441.0,"discounted_cash":864.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95909 NERVE CONDUCTION STUDIES 5-6 STUDIES","code_information":[{"code":"9220051","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95909","type":"HCPCS"}],"standard_charges":[{"gross_charge":2161.0,"discounted_cash":1296.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95910 NERVE CONDUCTION STUDIES 7-8 STUDIES","code_information":[{"code":"9220052","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95910","type":"HCPCS"}],"standard_charges":[{"gross_charge":2879.0,"discounted_cash":1727.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95911 NERVE CONDUCTION STUDIES 9-10 STUDIES","code_information":[{"code":"9220053","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95911","type":"HCPCS"}],"standard_charges":[{"gross_charge":3603.0,"discounted_cash":2161.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95912 NERVE CONDUCTION STUDIES 11-12 STUDIES","code_information":[{"code":"9220054","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95912","type":"HCPCS"}],"standard_charges":[{"gross_charge":4321.0,"discounted_cash":2592.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95913 NERVE CONDUCTION STUDIES 13 OR MORE STUDIES","code_information":[{"code":"9220055","type":"CDM"},{"code":"0922","type":"RC"},{"code":"95913","type":"HCPCS"}],"standard_charges":[{"gross_charge":5039.0,"discounted_cash":3023.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36430 BLOOD TRANSFUSION","code_information":[{"code":"9400002","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1213.0,"discounted_cash":727.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36430 BLOOD TRANSFUSION ADMIN LEVEL II","code_information":[{"code":"9400003","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2410.0,"discounted_cash":1446.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36511 APHERESIS-WBC EXCHANGE","code_information":[{"code":"9400008","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36511","type":"HCPCS"}],"standard_charges":[{"gross_charge":4948.0,"discounted_cash":2968.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36512 APHERESIS-RBC EXCHANGE","code_information":[{"code":"9400009","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36512","type":"HCPCS"}],"standard_charges":[{"gross_charge":4948.0,"discounted_cash":2968.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36513 APHERESIS FOR PLATELETS","code_information":[{"code":"9400010","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":3934.0,"discounted_cash":2360.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36514 APHERESIS FOR PLASMA EXCHANGE","code_information":[{"code":"9400012","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":4301.0,"discounted_cash":2580.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36591 COLLECT BLD SPEC IMPLNT VENOUS AC DV","code_information":[{"code":"9400015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC COLLECT BLD SPEC EST CENT/PER VEN LN","code_information":[{"code":"9400016","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":251.0,"discounted_cash":150.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMCOP"}]},{"description":"HC 90471 IMMUNIZATION ADMIN, ONE VACCINE","code_information":[{"code":"9400017","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96360 IV INF,HYDR;INIT 31 MIN TO  1 HOUR","code_information":[{"code":"9400018","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96361 IV INF,HYDR; EA ADD'L HR","code_information":[{"code":"9400019","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96365 IV INFUS TH/PRO/DX, INITIAL, UP TO 1 HR","code_information":[{"code":"9400020","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":388.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96366 IV INF,TH/PRO/DX EA ADD' HR","code_information":[{"code":"9400021","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96367 IV INF,TH/PRO/DX; SEQ UP TO 1 HR","code_information":[{"code":"9400022","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":388.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96368 IV INF,TH/PRO/DX;CONC UP TO 1 HR","code_information":[{"code":"9400023","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":388.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96372 INJ,THER,PROPH,DX; SQ OR IM","code_information":[{"code":"9400024","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":677.0,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96374 IV THER/PROPH/DX, SNGL/INIT PUSH","code_information":[{"code":"9400025","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96375 IV THER/PROPH/DX,EA ADDL SEQ-PUSH NEW","code_information":[{"code":"9400026","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96376 IV THER/PROPH/DX,EA ADD'L SEQ PUSH SAME","code_information":[{"code":"9400027","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96521 REFILL/MAINTAINACE OF  PORTABLE PUMP","code_information":[{"code":"9400028","type":"CDM"},{"code":"0940","type":"RC"},{"code":"96521","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":461.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96522 REFILL/ MAIN IMPLNT PMP/RES DRUG SYST","code_information":[{"code":"9400029","type":"CDM"},{"code":"0940","type":"RC"},{"code":"96522","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":523.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96523 IRRIG IMPLNT VAD (MAINT) W/O PROC","code_information":[{"code":"9400030","type":"CDM"},{"code":"0940","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.0,"discounted_cash":350.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99195 PHLEBOTOMY, THERAPEUTIC","code_information":[{"code":"9400036","type":"CDM"},{"code":"0940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.0,"discounted_cash":234.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ADMINISTRATION INFLUENZA VACCINE","code_information":[{"code":"9400039","type":"CDM"},{"code":"0771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ADMINISTRATION PNEUMOCOCCAL VACCINE","code_information":[{"code":"9400040","type":"CDM"},{"code":"0771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0101 SCREENING BREAST AND PELVIC EXAM","code_information":[{"code":"9400041","type":"CDM"},{"code":"0770","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0102 PROSTATE CA SCREEN DIGITAL RECTAL EXAM","code_information":[{"code":"9400042","type":"CDM"},{"code":"0770","type":"RC"},{"code":"G0102","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38221 PRO DIAGNOSTIC BONE MARROW; BIOPSY","code_information":[{"code":"9400043","type":"CDM"},{"code":"0940","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1701.0,"discounted_cash":1020.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90472 IMMUNIZATION ADM,EA ADD'L VACCINE","code_information":[{"code":"9400044","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NITRIC OXIDE PER HOUR","code_information":[{"code":"9400101","type":"CDM"},{"code":"0940","type":"RC"},{"code":"9400101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1183.0,"discounted_cash":709.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3906 OT WRIST-HAND ORTHOSIS W/O JOINTS CUST FAB","code_information":[{"code":"9400105","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3906","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":291.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3908 OT WRIST COCK-UP NON-MOLDED","code_information":[{"code":"9400106","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3933 OT FINGER ORTHOSIS W/O JOINTS CUST FAB","code_information":[{"code":"9400107","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3933","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":124.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3650 OT SHOULDER FIG 8 ABDUCT RESTRAINT","code_information":[{"code":"9400108","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3650","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3671 OT SHOULDER ORTHOSIS CAP DESIGN W/O JOINTS CUST FAB","code_information":[{"code":"9400109","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3671","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3702 OT ELBOW ORTHOSIS W/O JOINTS CUST FAB","code_information":[{"code":"9400110","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3702","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":163.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3808 OT WRIST-HAND-FINGER ORTHOSIS, RIGID W/O JOINTS","code_information":[{"code":"9400111","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3807 OT WRIST-HAND-FINGER ORTHOSIS STATIC THUMB SPICA","code_information":[{"code":"9400112","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3807","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3923 OT HAND-FINGER ORTHOSIS STATIC CMC BRACE","code_information":[{"code":"9400113","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3923","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3929 OT HAND-FINGER ORTHOSIS STATIC DYNAMIC","code_information":[{"code":"9400114","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3929","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3925 OT FINGER ORTHOSIS DYNAMIC KNUCKLE BENDER","code_information":[{"code":"9400115","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3925","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3927 OT FINGER ORTHOSIS STATIC OR RING OVAL","code_information":[{"code":"9400116","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3927","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3913 OT HAND-FINGER ORTHOSIS STATIC HAND BASED THUMB SPICA","code_information":[{"code":"9400117","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3913","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3905 CUSTOM SPLINT FABRICTN-HND/WRST","code_information":[{"code":"9400180","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3905","type":"HCPCS"}],"standard_charges":[{"gross_charge":898.0,"discounted_cash":538.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3935 CUSTOM SPLINT FABRICTN-FINGER","code_information":[{"code":"9400181","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3935","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THRX APHERESIS W HDL DELIP/PLASMA REINFUSN","code_information":[{"code":"9400185","type":"CDM"},{"code":"0940","type":"RC"},{"code":"0342T","type":"HCPCS"}],"standard_charges":[{"gross_charge":7496.0,"discounted_cash":4497.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3919 CUSTOM SPLINT FABRICTN-HAND","code_information":[{"code":"9400191","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3919","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":148.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3921 CUSTOM SPLINT FABRICTN-FINGER ONE OR MORE","code_information":[{"code":"9400192","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3921","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3760 OT ADJ JT PREFAB CUSTOM FIT","code_information":[{"code":"9400229","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3760","type":"HCPCS"}],"standard_charges":[{"gross_charge":442.0,"discounted_cash":265.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3806 OT WRIST-HAND-FINGER ORTHO W/JT CUSTOM FAB","code_information":[{"code":"9400230","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3806","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":240.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3981 OT UPPER EXT FX ORTH SHLDR CAP FOREARM","code_information":[{"code":"9400231","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3981","type":"HCPCS"}],"standard_charges":[{"gross_charge":889.0,"discounted_cash":533.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC L3763 OT ELBOW-WRIST-HAND RIGID W/O JTS CUSTOM FAB","code_information":[{"code":"9400232","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":396.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36470 INJ SCLEROSING SOL SINGLE INCOMP V OTHER THAN TELANGIECTASIA","code_information":[{"code":"9400235","type":"CDM"},{"code":"0940","type":"RC"},{"code":"36470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.0,"discounted_cash":1107.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC M0243 CASIRIVI AND IMDEVI FUSION","code_information":[{"code":"9400270","type":"CDM"},{"code":"0771","type":"RC"},{"code":"M0243","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":521.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC M0245 BAMLAN AND ETESEV INFUSION AND POST ADMIN MONITORING","code_information":[{"code":"9400271","type":"CDM"},{"code":"0771","type":"RC"},{"code":"M0245","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":521.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC M0247 INTRAVENOUS INFUSE SOTROVIMAB INCL INFUSE-POST ADMIN MONITORING","code_information":[{"code":"9400272","type":"CDM"},{"code":"0771","type":"RC"},{"code":"M0247","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":521.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96377 APPLY ON-BODY INJECTR FOR SUBQ INJ","code_information":[{"code":"9400275","type":"CDM"},{"code":"0940","type":"RC"},{"code":"96377","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC M0220 TIXAGEV AND CILGAV ASTRA ZENECA INJ ADMIN & POST MONITORING","code_information":[{"code":"9400280","type":"CDM"},{"code":"0771","type":"RC"},{"code":"M0220","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97802 MED NUTRITION THERAPY ASSESS EA 15 MIN","code_information":[{"code":"9420002","type":"CDM"},{"code":"0942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97803 MEDICAL NUTR THER, RE-ASSES, EA 15 MN","code_information":[{"code":"9420004","type":"CDM"},{"code":"0942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":100.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97804 MEDICAL NUTR THER, GROUP, EA 30 MN","code_information":[{"code":"9420005","type":"CDM"},{"code":"0942","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GEST DIAB/HYPERGLYCEMIA PREG FO","code_information":[{"code":"9420008","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0108 DIABETES SELF-MGMT TRAIN IND, PER 30 MIN","code_information":[{"code":"9420016","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC GROUP DIAB SELF MNG PER 30 MIN","code_information":[{"code":"9420017","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.0,"discounted_cash":94.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MED NUTR THER,RE-ASSESS,2ND REF-EA 15MIN","code_information":[{"code":"9420018","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SMOKING CESSATION SYMPTOMATIC PT <10 MIN","code_information":[{"code":"9420020","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SMOKING CESSATION SYMPTOMATIC PT >10 MIN","code_information":[{"code":"9420021","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SMOKING CESSATION ASYMPTOMATIC PT <10 MIN","code_information":[{"code":"9420022","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SMOKING CESSATION ASYMPTOMATIC PT >10 MIN","code_information":[{"code":"9420023","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":60.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99078 GROUP HEALTH EDUCATION","code_information":[{"code":"9420027","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99078","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.0,"discounted_cash":169.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0446 BEHAVIOR THERAPY CARDIVASCULAR DISEASE","code_information":[{"code":"9420028","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0446","type":"HCPCS"}],"standard_charges":[{"gross_charge":114.0,"discounted_cash":68.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0271 MEDICAL NUTRITION THERAPY, RE-ASSESS, GROUP (2 OR MORE IND), EA 30 MIN","code_information":[{"code":"9420030","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10060 PRO INCISION & DRAINAGE OF ABSCESS; SIMPLE OR SINGLE","code_information":[{"code":"9600097","type":"CDM"},{"code":"0960","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10061 PRO I&D ABSCESS COMPLICATED OR MULTIPLE","code_information":[{"code":"9600098","type":"CDM"},{"code":"0960","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":379.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10120 PRO INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE","code_information":[{"code":"9600100","type":"CDM"},{"code":"0960","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":388.0,"discounted_cash":232.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10140 I & D HEMATOMA, SEROMA, FLUID","code_information":[{"code":"9600101","type":"CDM"},{"code":"0960","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":248.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11042 PRO DEBRIDEMENT, SUBCUTANEOUS TISSUE, 1ST 20 SQ CM OR LESS","code_information":[{"code":"9600104","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11043 PRO DEBRIDE MUSCLE & SUBCU TISSUE-WOUND","code_information":[{"code":"9600106","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.0,"discounted_cash":421.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC11044 PRO DEBRIDE MUSCLE,SUB TIS,BONE-WOUND","code_information":[{"code":"9600107","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":892.0,"discounted_cash":535.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11055 PRO PARING BENIGN SKIN LESION; SINGLE","code_information":[{"code":"9600108","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PARING SINGLE BENIGN LESION-WOUND","code_information":[{"code":"9600109","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11056 PRO PARING/CUTTING BENIGN HYPERKERATOTIC LESION; 2 TO 4 LESIONS","code_information":[{"code":"9600110","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11057 PRO PARING/CUTTING BENIGN HYPERKERATOTIC LESION; > 4 LESIONS","code_information":[{"code":"9600111","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11057","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11719 PRO TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER","code_information":[{"code":"9600131","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11720 PRO DEBRIDEMENT OF NAILS BY ANY METHOD,1-5","code_information":[{"code":"9600132","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11720","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":67.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11721 PRO DEBRIDEMENT OF NAILS BY ANY METHOD; 6 OR MORE","code_information":[{"code":"9600133","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11721","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11730 PRO AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE","code_information":[{"code":"9600134","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AVULSION EACH ADD NAIL","code_information":[{"code":"9600136","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11732","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":151.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11750 PRO EXCISION NAIL & MATRIX PERMANENT REMOVAL","code_information":[{"code":"9600139","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11750","type":"HCPCS"}],"standard_charges":[{"gross_charge":640.0,"discounted_cash":384.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SIM REP,SLP,NCK,AXL,TRK,EXT<=2.5","code_information":[{"code":"9600142","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":187.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SIM REP,SLP,NCK,AX,TRK,EXT 2.6-7.5","code_information":[{"code":"9600143","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SIM REP,SLP,NCK,AXL,TRK,EXT 2.6-7.5","code_information":[{"code":"9600144","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":211.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLOS, SCLP,SCL,TRK,EXTM<=2.5","code_information":[{"code":"9600145","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLOS,SCLP,AXL,TRK,EXT,2.6-7.5","code_information":[{"code":"9600146","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.0,"discounted_cash":329.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLOS,SCLP,AXL,TRK,EXT,7.6-12.5","code_information":[{"code":"9600147","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":347.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 17110 PRO  DESTRUCTION OF BENIGN LESIONS; UP TO 14 LESIONS","code_information":[{"code":"9600163","type":"CDM"},{"code":"0960","type":"RC"},{"code":"17110","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BX HC BONE TROCAR/NDLE SUPERFICIAL","code_information":[{"code":"9600166","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1297.0,"discounted_cash":778.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BX HC BONE TROCAR/NDLE DEEP","code_information":[{"code":"9600167","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1313.0,"discounted_cash":787.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20550 PRO INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS","code_information":[{"code":"9600170","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 30901 PRO CONTRL NASAL HEMORRHAGE ANTERIOR SIMPLE","code_information":[{"code":"9600178","type":"CDM"},{"code":"0960","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":705.0,"discounted_cash":423.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 31500 PRO INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE","code_information":[{"code":"9600179","type":"CDM"},{"code":"0960","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":685.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38220 PRO DIAGNOSTIC BONE MARROW; ASPIRATION","code_information":[{"code":"9600180","type":"CDM"},{"code":"0960","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38220 PRO BONE MARROW ASPIRATION EA ADD'L","code_information":[{"code":"9600181","type":"CDM"},{"code":"0960","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":343.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 38221 PRO DIAGNOSTIC BONE MARROW; BIOPSY","code_information":[{"code":"9600182","type":"CDM"},{"code":"0960","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38221 PRO BONE MARROW BIOPSY EACH ADD'L","code_information":[{"code":"9600183","type":"CDM"},{"code":"0960","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":343.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 62270 PRO SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC","code_information":[{"code":"9600202","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REM/REV PERIPH/GAST NEUROSTIM GEN/REC","code_information":[{"code":"9600206","type":"CDM"},{"code":"0960","type":"RC"},{"code":"64595","type":"HCPCS"}],"standard_charges":[{"gross_charge":539.0,"discounted_cash":323.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSCRN DOPPLER INTRACRN ARTER COMP","code_information":[{"code":"9600224","type":"CDM"},{"code":"0960","type":"RC"},{"code":"93886","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":148.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC TRANSCRN DOPPLER INTRACRN ARTER LTD","code_information":[{"code":"9600225","type":"CDM"},{"code":"0960","type":"RC"},{"code":"93888","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC TENSILON TEST FOR MYASTHENIA GRAVIS","code_information":[{"code":"9600230","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95857","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EMG 1 EXT W/ OR W/O PARASPINAL","code_information":[{"code":"9600231","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95860","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":193.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC EMG 2 EXT W/ OR W/O PARASPINAL","code_information":[{"code":"9600232","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95861","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":280.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC GUIDE NERVE DESTR,NEEDLE HC EMG","code_information":[{"code":"9600236","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95874","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC NEUROMUSCULAR JUNCTION TEST, EA NRV","code_information":[{"code":"9600239","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95937","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":112.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 97597 PRO SELECT DEBRIDEMENT FIRST 20 SQ CM OR <","code_information":[{"code":"9600244","type":"CDM"},{"code":"0960","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MEDICAL NUTRIT THERAPY,INITL EA 15 MIN","code_information":[{"code":"9600249","type":"CDM"},{"code":"0960","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MEDICAL NUTRIT THRPY,RE-ASSES, EA 15 MIN","code_information":[{"code":"9600250","type":"CDM"},{"code":"0960","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":37.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTEOPATHIC MAN TX (OMT); 1-2 REGION","code_information":[{"code":"9600251","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98925","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":88.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99203 OP VISIT, NEW PT, LEVEL IIIA","code_information":[{"code":"9600259","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99204 OP VISIT, NEW PT, LEVEL IVA","code_information":[{"code":"9600261","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, NEW PT, EXTENDED","code_information":[{"code":"9600262","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":213.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99205 OP VISIT, NEW PT, LEVEL VA","code_information":[{"code":"9600263","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, NEW PT, COMPLEX","code_information":[{"code":"9600265","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99211 OP VISIT, EST PT, LEVEL IA","code_information":[{"code":"9600266","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, ESTAB PT, BRIEF","code_information":[{"code":"9600268","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99212 OP VISIT, EST PT, LEVEL IIA","code_information":[{"code":"9600269","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, ESTAB PT, LIMITED","code_information":[{"code":"9600270","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.0,"discounted_cash":64.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99213 OP VISIT, EST PT, LEVEL IIIA","code_information":[{"code":"9600271","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, ESTAB PT, INTERMED","code_information":[{"code":"9600274","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99214 OP VISIT, EST PT, LEVEL IVA","code_information":[{"code":"9600275","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, ESTAB PT, EXTENDED","code_information":[{"code":"9600277","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":166.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99215 OP VISIT, EST PT, LEVEL VA","code_information":[{"code":"9600278","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, ESTAB PT, COMPLEX","code_information":[{"code":"9600280","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99234 PRO IP/OBSV ADM/DC SAME DAY SF/LOW MDM 45 MIN","code_information":[{"code":"9600296","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99234","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.0,"discounted_cash":261.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99235 PRO IP/OBSV ADM/DC SAME DAY MOD MDM 70 MIN","code_information":[{"code":"9600297","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99235","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99236 PRO IP/OBSV ADM/DC SAME DAY HIGH MDM 85 MIN","code_information":[{"code":"9600298","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99236","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":429.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99242 PRO CONSULTATION FOR A NEW OR ESTABLISHED PATIENT; 30 MINUTES","code_information":[{"code":"9600302","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":158.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99243 PRO OP CONSULT LOW MDM 30 MIN NEW/EST","code_information":[{"code":"9600305","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":220.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99244 PRO OP CONSULT MOD MDM 40 MIN NEW/EST","code_information":[{"code":"9600308","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":340.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99245 PRO OP CONSULT HIGH MDM 55 MIN NEW/EST","code_information":[{"code":"9600311","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.0,"discounted_cash":427.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99291 PRO CRIT CARE 30-74 MIN","code_information":[{"code":"9600320","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99292 PRO CRITICAL CARE, EA ADD 30 MIN","code_information":[{"code":"9600321","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SCREENING BREAST/PELVIC EXAM","code_information":[{"code":"9600356","type":"CDM"},{"code":"0960","type":"RC"},{"code":"G0101","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PROSTATE CA SCREEN, DIGITAL RECTAL","code_information":[{"code":"9600357","type":"CDM"},{"code":"0960","type":"RC"},{"code":"G0102","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99242 OP CONSULTATION-LEVEL-II","code_information":[{"code":"9600361","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99243 OP CONSULTATION, LEVEL-III","code_information":[{"code":"9600362","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99244 OP CONSULTATION, LEVEL-IV","code_information":[{"code":"9600363","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":331.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99245 OP CONSULTATION-LEVEL-V","code_information":[{"code":"9600364","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":448.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP CONSULTATION, LEVEL III","code_information":[{"code":"9600366","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.0,"discounted_cash":237.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP CONSULTATION, LEVEL IV A","code_information":[{"code":"9600367","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":331.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP CONSULTATION, LEVEL V A","code_information":[{"code":"9600369","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":448.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IP CONSULTATION, INITIAL, LEVEL IIA","code_information":[{"code":"9600371","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99252","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IP CONSULTATION, INITIAL, LEVEL IIIA","code_information":[{"code":"9600372","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99253","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IP CONSULTATION, INITIAL, LEVEL IVA","code_information":[{"code":"9600373","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99254","type":"HCPCS"}],"standard_charges":[{"gross_charge":574.0,"discounted_cash":344.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC IP CONSULTATION, INITIAL, LEVEL VA","code_information":[{"code":"9600374","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99255","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRIT CARE 30-74 MIN","code_information":[{"code":"9600375","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRITICAL CARE, EA ADD 30 MIN","code_information":[{"code":"9600376","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.0,"discounted_cash":446.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPINAL PUNCTURE,LUMBAR,DIAGNSTIC","code_information":[{"code":"9600377","type":"CDM"},{"code":"0987","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTERIAL CATH INSERTION","code_information":[{"code":"9600378","type":"CDM"},{"code":"0987","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT NON-TUNNELED CVP >5YRS","code_information":[{"code":"9600379","type":"CDM"},{"code":"0987","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":285.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, INITIAL, LEVEL IA","code_information":[{"code":"9600380","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99221","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":133.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, INITIAL, LEVEL IIA","code_information":[{"code":"9600381","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":220.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, INITIAL, LEVEL IIA","code_information":[{"code":"9600382","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.0,"discounted_cash":220.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, INITIAL, LEVEL IIIA","code_information":[{"code":"9600383","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":301.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, SUBSEQUENT, LEVEL IA","code_information":[{"code":"9600384","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, SUBSEQUENT, LEVEL IB","code_information":[{"code":"9600385","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, SUBSEQUENT, LEVEL IIA","code_information":[{"code":"9600386","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL CARE, SUBSEQUENT, LEVEL IIIA","code_information":[{"code":"9600387","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":154.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL DISCH DAY MGMT, UP TO 30 MN-A","code_information":[{"code":"9600388","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HOSPITAL DISCH DAY MGMT, > 30 MINS-A","code_information":[{"code":"9600389","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PC INC/DRN ABCSS/CYST SMPL SINGL","code_information":[{"code":"9600392","type":"CDM"},{"code":"0982","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":607.0,"discounted_cash":364.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SIM REP,SLP,NCK,AX,TRK,EXT7.6-12.5CM","code_information":[{"code":"9600404","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":361.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SIM REP,FCE,EAR,EYE,NSE,LIP, MM 2.6-5CM","code_information":[{"code":"9600406","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":970.0,"discounted_cash":582.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLOS FACE,EAR,EYE,NSE,LP,MM 2.6-5CM","code_information":[{"code":"9600414","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":915.0,"discounted_cash":549.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL OF TONGS/HALO APPLIED DIFF MD","code_information":[{"code":"9600423","type":"CDM"},{"code":"0982","type":"RC"},{"code":"20665","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.0,"discounted_cash":286.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX INTRPH JOINT DISL,SNG W/MAN","code_information":[{"code":"9600426","type":"CDM"},{"code":"0960","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.0,"discounted_cash":925.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28190 PRO REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS-LT","code_information":[{"code":"9600427","type":"CDM"},{"code":"0960","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28190 PRO REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS-RT","code_information":[{"code":"9600428","type":"CDM"},{"code":"0960","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 31575 PRO LARYNGOSCOPY,FLEXIBLE,DIAGNOSTIC","code_information":[{"code":"9600443","type":"CDM"},{"code":"0982","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT NON-TUNNELED CVP >5YRS  O/P","code_information":[{"code":"9600444","type":"CDM"},{"code":"0982","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":285.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38220 PRO DIAGNOSTIC BONE MARROW; ASPIRATION","code_information":[{"code":"9600445","type":"CDM"},{"code":"0982","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38220 PRO BONE MARROW ASPIRATION EA ADD'L","code_information":[{"code":"9600446","type":"CDM"},{"code":"0982","type":"RC"},{"code":"38220","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":343.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC 38221 PRO DIAGNOSTIC BONE MARROW; BIOPSY","code_information":[{"code":"9600447","type":"CDM"},{"code":"0982","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38221 PRO BONE MARROW BIOPSY EACH ADD'L","code_information":[{"code":"9600448","type":"CDM"},{"code":"0982","type":"RC"},{"code":"38221","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":343.8,"setting":"both","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"description":"HC SPINAL PUNCTURE,LUMBAR,DIAGNSTIC","code_information":[{"code":"9600458","type":"CDM"},{"code":"0982","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99202 PRO OUTPATIENT VISIT, NEW PATIENT, LEVEL II","code_information":[{"code":"9600472","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":181.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, NEW PT, LEVEL IIB","code_information":[{"code":"9600473","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":133.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99203 PRO OUTPATIENT VISIT, NEW PATIENT, LEVEL III","code_information":[{"code":"9600474","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99204 PRO OUTPATIENT VISIT, NEW PATIENT, LEVEL IV","code_information":[{"code":"9600476","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":334.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, NEW PT, LEVEL IVB","code_information":[{"code":"9600477","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99205 PRO OUTPATIENT VISIT, NEW PATIENT, LEVEL V","code_information":[{"code":"9600478","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, NEW PT, LEVEL VB","code_information":[{"code":"9600479","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, EST PT, LEVEL IB","code_information":[{"code":"9600481","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99212 PRO OUTPATIENT VISIT, ESTABLISHED PATIENT, LEVEL II","code_information":[{"code":"9600482","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":139.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, EST PT, LEVEL IIB","code_information":[{"code":"9600483","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99213 PRO OUTPATIENT VISIT, ESTABLISHED PATIENT, LEVEL III","code_information":[{"code":"9600484","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, EST PT, LEVEL IIIB","code_information":[{"code":"9600485","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":156.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99214 PRO OUTPATIENT VISIT, ESTABLISHED PATIENT, LEVEL IV","code_information":[{"code":"9600486","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":244.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99215 PRO OUTPATIENT VISIT, ESTABLISHED PATIENT, LEVEL V","code_information":[{"code":"9600488","type":"CDM"},{"code":"0982","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":290.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, EST PT, LEVEL VB","code_information":[{"code":"9600489","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":231.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 38222 PRO DIAGNOSTIC BONE MARROW BX & ASPIR","code_information":[{"code":"9600493","type":"CDM"},{"code":"0982","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.0,"discounted_cash":681.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ASMBLE & OPER PUMPW/O2 OR HEAT EXCHANGE EA HR","code_information":[{"code":"9600494","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99190","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":838.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ASMBLE & OPER PUMPW/O2 OR HEAT EXCHANGE 45 MINS","code_information":[{"code":"9600495","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99191","type":"HCPCS"}],"standard_charges":[{"gross_charge":979.0,"discounted_cash":587.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ASMBLE & OPER PUMPW/O2 OR HEAT EXCHANGE 30 MINS","code_information":[{"code":"9600496","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99192","type":"HCPCS"}],"standard_charges":[{"gross_charge":561.0,"discounted_cash":336.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 92950 PRO CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST)","code_information":[{"code":"9600497","type":"CDM"},{"code":"0960","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1883.0,"discounted_cash":1129.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MEDICAL NUTRIT THERAPY,GROUP, 30 MIN","code_information":[{"code":"9600499","type":"CDM"},{"code":"0960","type":"RC"},{"code":"97804","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 96450 PRO CHEMO ADM INTO CNS INCL SPINAL PUNCTURE","code_information":[{"code":"9600501","type":"CDM"},{"code":"0982","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12005 PRO SIM REP,SLP,NCK,AX,TRK,EXT 12.6-20","code_information":[{"code":"9600511","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95864 EMG, 4 EXT W/ OR W/O PARASPINAL","code_information":[{"code":"9600522","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95864","type":"HCPCS"}],"standard_charges":[{"gross_charge":622.0,"discounted_cash":373.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 64405 ANES GREATER OCCIPITAL NERVE - RT","code_information":[{"code":"9600538","type":"CDM"},{"code":"0960","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64405 ANES GREATER OCCIPITAL NERVE - LT","code_information":[{"code":"9600539","type":"CDM"},{"code":"0960","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64405 ANES GREATER OCCIPITAL NERVE - BILAT","code_information":[{"code":"9600540","type":"CDM"},{"code":"0960","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":411.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 20526 INJ THERAPEUTIC, CARPAL TUNNEL-RT","code_information":[{"code":"9600541","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20526 INJ THERAPEUTIC, CARPAL TUNNEL-LT","code_information":[{"code":"9600542","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20526 INJ THERAPEUTIC, CARPAL TUNNEL-BILAT","code_information":[{"code":"9600543","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20526","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.0,"discounted_cash":277.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 11045 PRO DEBRIDE SUBQ TISSUE EA ADD 20SQ CM","code_information":[{"code":"9600551","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95867 EMG CRANIAL NERVE MUSCLES, UNIL-RT","code_information":[{"code":"9600560","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":171.0,"setting":"both","modifier_code":["26","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 95867 EMG CRANIAL NERVE MUSCLES, UNIL-LT","code_information":[{"code":"9600561","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95867","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":171.0,"setting":"both","modifier_code":["26","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 95868 EMG CRANIAL NERVE MUSCLE, BILAT","code_information":[{"code":"9600562","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95868","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":252.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 15271 PRO APP HIGH COST SKIN SUB TRUNK,ARMS,LEGS FIRST 25 SQ CM","code_information":[{"code":"9600563","type":"CDM"},{"code":"0960","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15272 PRO APP HIGH COST SKIN SUB TRUNK,ARMS,LEGS EA ADDTL 25 SQ CM","code_information":[{"code":"9600564","type":"CDM"},{"code":"0960","type":"RC"},{"code":"15272","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49082 ABD PARACENTESIS W/O IMAG GUID","code_information":[{"code":"9600574","type":"CDM"},{"code":"0960","type":"RC"},{"code":"49082","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 49083 PRO ABD PARACENTESIS W IMAGE GUIDANCE","code_information":[{"code":"9600575","type":"CDM"},{"code":"0960","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":520.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20552 PRO INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)","code_information":[{"code":"9600579","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20600 PRO INJ ARTHRO,SM JT/BURSA/GAN W/O US GUIDE-RT","code_information":[{"code":"9600662","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20600 PRO INJ ARTHRO,SM JT/BURSA/GAN W/O US GUIDE-BLT","code_information":[{"code":"9600663","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.0,"discounted_cash":549.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 99464 PRO ATTENDANCE AT DELIVERY AND INITIAL STABILIZATION OF NEWBORN","code_information":[{"code":"9600664","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99464","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":127.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99360 PRO STANDBY SERVICE, C-SECTION, PROLONG ATTEND, EA 30 MIN","code_information":[{"code":"9600665","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99360","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99465 PRO DELIVERY/BIRTHING ROOM NEWBORN RESUSCITATION","code_information":[{"code":"9600666","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":463.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36660 PRO CATHETERIZATION, UMBILICAL ARTERY, NEWBORN, FOR DIAG OR THERAPY","code_information":[{"code":"9600667","type":"CDM"},{"code":"0960","type":"RC"},{"code":"36660","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":88.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99460 PRO INITIAL HOSPITAL/BIRTHING CENTER CARE, PER DAY, E&M, NORMAL NEWBORN","code_information":[{"code":"9600668","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99460","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":168.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99462 PRO SUBSEQUENT HOSPITAL CARE, PER DAY, FOR E & M OF NORMAL NEWBORN","code_information":[{"code":"9600669","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99462","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99463 PRO INITIAL HOSP CARE, PER DAY, E&M NORM NEWBORN ADMIT & DISCH SAME DAY","code_information":[{"code":"9600670","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99463","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT NON-TUNNELED CVP < 5 YRS","code_information":[{"code":"9600671","type":"CDM"},{"code":"0960","type":"RC"},{"code":"36555","type":"HCPCS"}],"standard_charges":[{"gross_charge":924.0,"discounted_cash":554.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12006 PRO SIM REP,SLP,NCK,AX,TRK,EXT 20.1-30 CM","code_information":[{"code":"9600676","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SIM REP,FCE,EAR,EYE,NSE,LP,MM12.6-20 CM","code_information":[{"code":"9600679","type":"CDM"},{"code":"0960","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":468.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20605 PRO ARTHROCENTESIS, ASPIRATION &/OR INJECT, INTERM JOINT/BURSA W/O US","code_information":[{"code":"9600686","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":389.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE-RT","code_information":[{"code":"9600688","type":"CDM"},{"code":"0982","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":389.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO INJ ARTHRO, INTRMED JT/BURSA/GAN W/O US GUIDE-LT","code_information":[{"code":"9600689","type":"CDM"},{"code":"0982","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.0,"discounted_cash":389.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 PRO ARTHROCENTESIS, ASPIRATION &/OR INJECT, MAJOR JT/BURSA; WO US GUIDE","code_information":[{"code":"9600690","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20610 PRO ARTHROCENTESIS, MAJR JT/BURSA/GAN; WO GUIDE-RT","code_information":[{"code":"9600691","type":"CDM"},{"code":"0982","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20610 PRO ARTHROCENTESIS, MAJR JT/BURSA/GAN; WO GUIDE-LT","code_information":[{"code":"9600692","type":"CDM"},{"code":"0982","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR,CPLX,EYELID,NSE,EAR,LP 2.6-7.5-FAC","code_information":[{"code":"9600700","type":"CDM"},{"code":"0960","type":"RC"},{"code":"13152","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":660.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 13101 PRO REPAIR,COMPLEX,TRUNK,2.6-7.5","code_information":[{"code":"9600703","type":"CDM"},{"code":"0960","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":847.0,"discounted_cash":508.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPAIR,COMPLEX,TRUNK,EA ADD 5 CM (OR <)","code_information":[{"code":"9600704","type":"CDM"},{"code":"0960","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20520 PRO REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE","code_information":[{"code":"9600706","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":360.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO INIT CARE PER DAY, E&M NORM NEWBORN OUT OF HOSP","code_information":[{"code":"9600736","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99461","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":168.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSITIONAL CARE MGMT SRVS W/I 14 DAYS-PRO","code_information":[{"code":"9600754","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99495","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":187.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSITIONAL CARE MGMT SRVS W/I 7 DAYS-PRO","code_information":[{"code":"9600755","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99496","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29425 PRO APPLICATION OF SHORT LEG CAS; WALKING OR AMBULATORY TYPE-RT","code_information":[{"code":"9600757","type":"CDM"},{"code":"0960","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29425 PRO APPLICATION OF SHORT LEG CAS; WALKING OR AMBULATORY TYPE-LT","code_information":[{"code":"9600758","type":"CDM"},{"code":"0960","type":"RC"},{"code":"29425","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 62320 PRO EPIDURAL NJX, CERV/THORACIC W/O IMAGING","code_information":[{"code":"9600760","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62320","type":"HCPCS"}],"standard_charges":[{"gross_charge":3186.0,"discounted_cash":1911.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62321 PRO EPIDURAL NJX,  CERV/THORACIC, WITH IMAGING","code_information":[{"code":"9600761","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62321","type":"HCPCS"}],"standard_charges":[{"gross_charge":5092.0,"discounted_cash":3055.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62322 PRO EPIDURAL NJX, LUMBAR/SACRAL W/O IMAGING","code_information":[{"code":"9600762","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62322","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62323 PRO EPIDURAL NJX, LUMBAR/SACRAL WITH IMAGING","code_information":[{"code":"9600763","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62324 PRO EPIDURAL INFUSION, CERVICAL OR THORACIC - NO IMAGING","code_information":[{"code":"9600764","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62324","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62325 PRO EPIDURAL INFUSION, CERVICAL OR THORACIC - WITH IMAGING","code_information":[{"code":"9600765","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62325","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":529.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64450 PRO INJECTION ANESTHESTIC AGENT OTHER PERIPHERAL NERVE OR BRANCH","code_information":[{"code":"9600771","type":"CDM"},{"code":"0960","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11755 PRO BIOPSY OF NAIL UNIT (SEPARATE PROCEDURE)","code_information":[{"code":"9600772","type":"CDM"},{"code":"0960","type":"RC"},{"code":"11755","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99211 PRO TCS VISIT EST PT LEVEL I","code_information":[{"code":"9600804","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99212 PRO TCS VISIT EST PT LEVEL II","code_information":[{"code":"9600805","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99213 PRO TCS VISIT EST PT LEVEL III","code_information":[{"code":"9600806","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":95.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99214 PRO TCS VISIT EST PT LEVEL IV","code_information":[{"code":"9600807","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":143.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99215 PRO TCS VISIT EST PT LEVEL V","code_information":[{"code":"9600808","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95976 PRO ELEC ALYS IMPLT SMPL CRANIAL NERVE NPGT PRGRMG","code_information":[{"code":"9600824","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.0,"discounted_cash":429.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 95977 PRO ELEC ALYS IMPLT CPLX CRANIAL NERVE NPGT PRGRMG","code_information":[{"code":"9600825","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":235.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28435 PRO CLSD TALUS FRACT,W/MANIP RT","code_information":[{"code":"9600826","type":"CDM"},{"code":"0960","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":889.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28435 PRO CLSD TALUS FRACT,W/MANIP LT","code_information":[{"code":"9600827","type":"CDM"},{"code":"0960","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":889.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27246 PRO CLOSED TRMT THIGH FRACTURE W/O MANIPULATION RT","code_information":[{"code":"9600828","type":"CDM"},{"code":"0960","type":"RC"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":751.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27246 PRO CLOSED TRMT THIGH FRACTURE W/O MANIPULATION LT","code_information":[{"code":"9600829","type":"CDM"},{"code":"0960","type":"RC"},{"code":"27246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1252.0,"discounted_cash":751.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27601 PRO DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY","code_information":[{"code":"9600830","type":"CDM"},{"code":"0960","type":"RC"},{"code":"27601","type":"HCPCS"}],"standard_charges":[{"gross_charge":1753.0,"discounted_cash":1051.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24675 PRO CLOSED TREATMENT ULNAR FRACTURE, PROXIMAL END; WITH MANIPULATION-RT","code_information":[{"code":"9600853","type":"CDM"},{"code":"0960","type":"RC"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":2787.0,"discounted_cash":1672.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24675 PRO CLOSED TREATMENT ULNAR FRACTURE, PROXIMAL END; WITH MANIPULATION-LT","code_information":[{"code":"9600854","type":"CDM"},{"code":"0960","type":"RC"},{"code":"24675","type":"HCPCS"}],"standard_charges":[{"gross_charge":2787.0,"discounted_cash":1672.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27532 PRO CLOSED TREAT TIBIAL FRACT, PROXIMAL; W OR WO MANIP, W TRACTION-RT","code_information":[{"code":"9600855","type":"CDM"},{"code":"0960","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":1936.0,"discounted_cash":1161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27532 PRO CLOSED TREAT TIBIAL FRACT, PROXIMAL; W OR WO MANIP, W TRACTION-LT","code_information":[{"code":"9600856","type":"CDM"},{"code":"0960","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":1936.0,"discounted_cash":1161.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 62328 PRO DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"9600867","type":"CDM"},{"code":"0960","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98966 PRO NONPHYSICIAN TELEPHONE ASSESS 5-10 MIN","code_information":[{"code":"9600892","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98966","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98967 PRO NONPHYSICIAN TELEPHONE ASSESS 11-20 MIN","code_information":[{"code":"9600893","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98967","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":84.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98968 PRO NONPHYSICIAN TELEPHONE ASSESS 21-30 MIN","code_information":[{"code":"9600894","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98968","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC G0271 PRO MEDICAL NUTRITION THERAPY, RE-ASSESS, GROUP (>=2 IND), EA 30 MIN","code_information":[{"code":"9600895","type":"CDM"},{"code":"0960","type":"RC"},{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20600 PRO INJ ARTHRO,SM JT/BURSA/GAN W/O US GUIDE-LT","code_information":[{"code":"9600896","type":"CDM"},{"code":"0960","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 99417 PRO PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN","code_information":[{"code":"9600897","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99417","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99281 PRO ED VISIT LEVEL I","code_information":[{"code":"9600951","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99282 PRO ED VISIT LEVEL II","code_information":[{"code":"9600952","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99283 PRO ED VISIT LEVEL III","code_information":[{"code":"9600953","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99284 PRO ED VISIT LEVEL IV","code_information":[{"code":"9600954","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":99.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99285 PRO ED VISIT LEVEL V","code_information":[{"code":"9600955","type":"CDM"},{"code":"0960","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98000 PRO SYNCH AUDIO-VIDEO NEW SF 15 MIN","code_information":[{"code":"9601005","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98000","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98001 PRO SYNCH AUDIO-VIDEO NEW LOW 30 MIN","code_information":[{"code":"9601006","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98001","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98002 PRO SYNCH AUDIO-VIDEO NEW MOD 45 MIN","code_information":[{"code":"9601007","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98002","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98003 PRO SYNCH AUDIO-VIDEO NEW HI 60 MIN","code_information":[{"code":"9601008","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98003","type":"HCPCS"}],"standard_charges":[{"gross_charge":359.0,"discounted_cash":215.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98004 PRO SYNCH AUDIO-VIDEO EST SF 10 MIN","code_information":[{"code":"9601009","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98004","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98005 PRO SYNCH AUDIO-VIDEO EST LOW 20 MIN","code_information":[{"code":"9601010","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98005","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98006 PRO SYNCH AUDIO-VIDEO EST MOD 30 MIN","code_information":[{"code":"9601011","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98006","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98007 PRO SYNCH AUDIO-VIDEO EST HI 40 MIN","code_information":[{"code":"9601012","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98007","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98008 PRO SYNCH AUDIO-ONLY NEW SF 15 MIN","code_information":[{"code":"9601013","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98008","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98009 PRO SYNCH AUDIO-ONLY NEW LOW 30 MIN","code_information":[{"code":"9601014","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98009","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98010 PRO SYNCH AUDIO-ONLY NEW MOD 45 MIN","code_information":[{"code":"9601015","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98010","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98011 PRO SYNCH AUDIO-ONLY NEW HIGH 60 MIN","code_information":[{"code":"9601016","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98011","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.0,"discounted_cash":196.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98012 PRO SYNCH AUDIO-ONLY EST SF 10 MIN","code_information":[{"code":"9601017","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98012","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":40.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98013 PRO SYNCH AUDIO-ONLY EST LOW 20 MIN","code_information":[{"code":"9601018","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98013","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":73.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98014 PRO SYNCH AUDIO-ONLY EST MOD 30 MIN","code_information":[{"code":"9601019","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98014","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":108.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98015 PRO SYNCH AUDIO-ONLY EST HIGH 40 MIN","code_information":[{"code":"9601020","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98015","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":160.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 98016 PRO BRIEF COMUNICAJ TECH-BSD SVC 5-10 MIN","code_information":[{"code":"9601021","type":"CDM"},{"code":"0960","type":"RC"},{"code":"98016","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90791 PRO PSYCHIATRIC DIAGNOSTIC EVALUATION","code_information":[{"code":"9610017","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":269.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90792 PRO PSYCHIATRIC DIAGNOST EVAL W/ MED SVCS","code_information":[{"code":"9610018","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90792","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.0,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99231 PRO SBSQ IP/OBSV CARE/DAY SF/LOW MDM 25 MIN","code_information":[{"code":"9610043","type":"CDM"},{"code":"0961","type":"RC"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99232 PRO SBSQ IP/OBSV CARE/DAY MOD MDM 35 MIN","code_information":[{"code":"9610044","type":"CDM"},{"code":"0961","type":"RC"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":129.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99233 PRO SBSQ IP/OBSV CARE/DAY HIGH MDM 50 MIN","code_information":[{"code":"9610045","type":"CDM"},{"code":"0961","type":"RC"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90832 PRO PSYCHOTHERAPY 30 MIN W/PT","code_information":[{"code":"9610067","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":108.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90833 PRO PSYCHOTHERAPY 30 MIN W/PT W/E&M SVC","code_information":[{"code":"9610068","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90833","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90834 PRO PSYCHOTHERAPY 45 MIN PT-EAP","code_information":[{"code":"9610069","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":147.0,"setting":"both","modifier_code":["HJ"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier HJ: Employee assistance program"}]},{"description":"HC 90834 PRO PSYCHOTHERAPY 45 MIN W/PT","code_information":[{"code":"9610070","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":245.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90836 PRO PSYCHOTHERAPY 45 MIN W/PT W/E&M","code_information":[{"code":"9610071","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90836","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":143.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90837 PRO PSYCHOTHERAPY 60 MIN W/PT","code_information":[{"code":"9610072","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90838 PRO PSYCHOTHERAPY 60 MIN W/PT W/E&M","code_information":[{"code":"9610073","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90838","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 PRO FAMILY PSYCHOTHERAPY W/O PT,50 MIN","code_information":[{"code":"9610074","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90847 PRO FAMILY PSYCHOTHERAPY W/ PT,50 MIN","code_information":[{"code":"9610075","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90846 OP FAMILY PSYCHOTHERAPY W/O PT,50 MIN","code_information":[{"code":"9610076","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90846","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 90847 OP FAMILY PSYCHOTHERAPY W/PT,50 MIN","code_information":[{"code":"9610077","type":"CDM"},{"code":"0961","type":"RC"},{"code":"90847","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TRANSPERINEAL PLAC PROST RAD INSERT","code_information":[{"code":"9730001","type":"CDM"},{"code":"0973","type":"RC"},{"code":"55875","type":"HCPCS"}],"standard_charges":[{"gross_charge":6320.0,"discounted_cash":3792.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC US TRANSRECT, PROS VOL,BRACHY PLAN","code_information":[{"code":"9730002","type":"CDM"},{"code":"0973","type":"RC"},{"code":"76873","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":492.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC THERAPEUTIC TREATMENT PLAN SIMPLE","code_information":[{"code":"9730005","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.0,"discounted_cash":883.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THERAPEUTIC TREATMENT PLAN INTERMD","code_information":[{"code":"9730007","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77262","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":1249.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THERAPEUTIC TREATMENT PLAN COMPLEX","code_information":[{"code":"9730008","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77263","type":"HCPCS"}],"standard_charges":[{"gross_charge":2689.0,"discounted_cash":1613.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RDT SIMPLE SIMULATION","code_information":[{"code":"9730009","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":418.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT INTERMEDIATE SIMULATION","code_information":[{"code":"9730010","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77285","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":522.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT COMPLEX SIMULATION","code_information":[{"code":"9730011","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1694.0,"discounted_cash":1016.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT 3-D THERAPY PLAN INC DOSE VOL HISTOGRAMS","code_information":[{"code":"9730012","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":4143.0,"discounted_cash":2485.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT BASIC DOSIMETRY CALC","code_information":[{"code":"9730013","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":301.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC IMRT TREATMENT PLANNING","code_information":[{"code":"9730014","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":7442.0,"discounted_cash":4465.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT SPECIAL PORT PLAN TOTAL BODY","code_information":[{"code":"9730018","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.0,"discounted_cash":1655.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT SPECIAL DOSIMETRY","code_information":[{"code":"9730022","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":227.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT TREATMENT DEVICE SIMPLE","code_information":[{"code":"9730023","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":271.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT TREATMENT DEVICE INTERMED","code_information":[{"code":"9730024","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":372.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT TREATMENT DEVICE COMPLEX","code_information":[{"code":"9730025","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":534.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC TREATMENT MGMT, PER 5 TREATMENTS","code_information":[{"code":"9730027","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77427","type":"HCPCS"}],"standard_charges":[{"gross_charge":1967.0,"discounted_cash":1180.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RDT THERAPY MANAGEMENT 1 OR2 FRAC","code_information":[{"code":"9730028","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77431","type":"HCPCS"}],"standard_charges":[{"gross_charge":1233.0,"discounted_cash":739.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STEREOTACTIC RADIATION TX CRANIAL","code_information":[{"code":"9730029","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77432","type":"HCPCS"}],"standard_charges":[{"gross_charge":2464.0,"discounted_cash":1478.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77435 SRS BDY MANAGE, LESION(S), + IMAG <=5","code_information":[{"code":"9730030","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77435","type":"HCPCS"}],"standard_charges":[{"gross_charge":4028.0,"discounted_cash":2416.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RDT SPECIAL TREATMENT PROC","code_information":[{"code":"9730031","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1465.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RDT INFUSE/INST RADIOELMNT SOL","code_information":[{"code":"9730032","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1465.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC INTRACAVITARY RAD SOURC APPL, SIMPLE","code_information":[{"code":"9730033","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1768.0,"discounted_cash":1060.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC INTRACAVITARY RAD SOURC APPL, INTERM","code_information":[{"code":"9730034","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":2640.0,"discounted_cash":1584.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC INTRACAVITARY RAD SOURC APPL, COMPLX","code_information":[{"code":"9730035","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":3899.0,"discounted_cash":2339.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC SUPERVISION, LOADING RAD SOURCE","code_information":[{"code":"9730047","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77790","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":372.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RADIOPHARMACEUTICAL THERAPY, ORAL ADMIN","code_information":[{"code":"9730048","type":"CDM"},{"code":"0973","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC RADIOLABLD MONOCLONAL ANTIBDY IV","code_information":[{"code":"9730049","type":"CDM"},{"code":"0973","type":"RC"},{"code":"79403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1314.0,"discounted_cash":788.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC OP VISIT, NEW PT, LEVEL IV","code_information":[{"code":"9730050","type":"CDM"},{"code":"0973","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":334.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OP VISIT, NEW PT, LEVEL V","code_information":[{"code":"9730051","type":"CDM"},{"code":"0973","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.0,"discounted_cash":417.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99211 PRO OP VISIT, EST PT, LEVEL I","code_information":[{"code":"9730052","type":"CDM"},{"code":"0973","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":91.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99212 PRO OP VISIT, EST PT, LEVEL II","code_information":[{"code":"9730053","type":"CDM"},{"code":"0973","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99213 PRO OP VISIT, EST PT, LEVEL III","code_information":[{"code":"9730054","type":"CDM"},{"code":"0973","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":148.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99221 PRO HOSPITAL CARE, INITIAL,LEVEL I","code_information":[{"code":"9730058","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99221","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99222 PRO HOSPITAL CARE, INITIAL,LEVEL II","code_information":[{"code":"9730059","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99222","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99223 PRO HOSPITAL CARE, INITIAL,LEVEL III","code_information":[{"code":"9730060","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99223","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99231 PRO HOSPITAL CARE, SUBSEQUENT,LEVEL I","code_information":[{"code":"9730061","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99231","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":132.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99232 PRO HOSPITAL CARE, SUBSEQUENT,LEVEL II","code_information":[{"code":"9730062","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99232","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99233 PRO HOSPITAL CARE, SUBSEQUENT,LEVEL III","code_information":[{"code":"9730063","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99233","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":245.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99238 PRO HOSPITAL DISCH DAY MGMT, UP TO 30 MN","code_information":[{"code":"9730064","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99238","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99239 PRO HOSPITAL DISCHARGE DAY MGMT, >30 MINS","code_information":[{"code":"9730065","type":"CDM"},{"code":"0987","type":"RC"},{"code":"99239","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":255.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99242 PRO OP CONSULTATION LEVEL II","code_information":[{"code":"9730067","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99243 PRO OP CONSULTATION LEVEL III","code_information":[{"code":"9730068","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.0,"discounted_cash":392.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99244 PRO OP CONSULTATION LEVEL IV","code_information":[{"code":"9730069","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":506.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99245 PRO OP CONSULTATION LEVEL V","code_information":[{"code":"9730070","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1077.0,"discounted_cash":646.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99252 PRO IP CONSULTATION LEVEL II","code_information":[{"code":"9730072","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99252","type":"HCPCS"}],"standard_charges":[{"gross_charge":582.0,"discounted_cash":349.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99253 PRO IP CONSULTATION LEVEL III","code_information":[{"code":"9730073","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99253","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":463.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99254/99222 PRO IP CONSULTATION LEVEL IV","code_information":[{"code":"9730074","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99254","type":"HCPCS"}],"standard_charges":[{"gross_charge":953.0,"discounted_cash":571.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99255/99223 PRO IP CONSULTATION LEVEL V","code_information":[{"code":"9730075","type":"CDM"},{"code":"0988","type":"RC"},{"code":"99255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1145.0,"discounted_cash":687.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MLC FOR IMRT,DESGN & CONSTR/IMRT PLN","code_information":[{"code":"9730076","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1063.0,"discounted_cash":637.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 99214 PRO OP VISIT, EST PT, LEVEL IV","code_information":[{"code":"9730077","type":"CDM"},{"code":"0973","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 99215 PRO OP VISIT, EST PT, LEVEL V","code_information":[{"code":"9730078","type":"CDM"},{"code":"0973","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":267.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT VAG RADIAT AFTERLOAD APPARATUS","code_information":[{"code":"9730085","type":"CDM"},{"code":"0973","type":"RC"},{"code":"57156","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.0,"discounted_cash":360.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RDT BASIC DOSIMETRY CALC EA ADDTL PHY","code_information":[{"code":"9730087","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":301.8,"setting":"both","modifier_code":["26","76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC RDT TREATMENT DEVICE COMPLEX EA ADDTL PHY","code_information":[{"code":"9730088","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":534.0,"setting":"both","modifier_code":["26","76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC PRO TELETHERAPY ISODOSE PLAN; SIMPLE, INC BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"9730091","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.0,"discounted_cash":1655.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO TELETHERAPY ISODOSE PLAN; COMPLEX, INC BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"9730092","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.0,"discounted_cash":1655.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO BRACHYTHERAPY ISODOSE PLAN; SIMPLE W BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"9730093","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.0,"discounted_cash":1655.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO BRACHYTHERAPY ISODOSE PLAN; INTERMEDIATE W BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"9730094","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.0,"discounted_cash":1655.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO BRACHYTHERAPY ISODOSE PLAN; COMPLEX W BASIC DOSIMETRY CALCULATION(S)","code_information":[{"code":"9730095","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.0,"discounted_cash":1655.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO RDT TREATMENT DEVICE SIMPLE-EA ADDTL PHY","code_information":[{"code":"9730112","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":271.8,"setting":"both","modifier_code":["26","76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC PRO RDT TREATMENT DEVICE INTERMED-EA ADDTL PHY","code_information":[{"code":"9730113","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":372.6,"setting":"both","modifier_code":["26","76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC RDT SIMPLE SIMULATION-SECOND DAILY SIM PHY","code_information":[{"code":"9730114","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.0,"discounted_cash":418.2,"setting":"both","modifier_code":["26","76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional"}]},{"description":"HC PRO UNLISTED CLINICAL BRACHYTHERAPY SMPL PHY","code_information":[{"code":"9730115","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77799","type":"HCPCS"}],"standard_charges":[{"gross_charge":2083.0,"discounted_cash":1249.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO HDR INTRSTL/INTRCVTY + BASIC DOSMTRY 1 CHNL","code_information":[{"code":"9730117","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77770","type":"HCPCS"}],"standard_charges":[{"gross_charge":3647.0,"discounted_cash":2188.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO HDR INTRSTL/INTRCVTY + BASIC DOSMTRY 2-12 CHNL","code_information":[{"code":"9730118","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77771","type":"HCPCS"}],"standard_charges":[{"gross_charge":5980.0,"discounted_cash":3588.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO UNLISTED CLINICAL BRACHYTHERAPY INTRMD PHY","code_information":[{"code":"9730121","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77799","type":"HCPCS"}],"standard_charges":[{"gross_charge":3296.0,"discounted_cash":1977.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO REM AFTERLOAD HDR OR BRACHY INC DOS;2.0 CM OR 1 CH--PHY","code_information":[{"code":"9730122","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77767","type":"HCPCS"}],"standard_charges":[{"gross_charge":3694.0,"discounted_cash":2216.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO REM AFTRLD HDR OR BRACHY INC DOS;2.0 CM OR 2-12 CH-PHY","code_information":[{"code":"9730123","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4910.0,"discounted_cash":2946.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO RADIOPHARMACEUTICAL TX IV ADMIN","code_information":[{"code":"9730124","type":"CDM"},{"code":"0973","type":"RC"},{"code":"79101","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":163.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC PRO CHEMOTHERAPY ADMIN INTO CNS","code_information":[{"code":"9730125","type":"CDM"},{"code":"0973","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":297.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO CHEMO ADMIN; INTRALESIONAL UP TO 7 LSNS","code_information":[{"code":"9730126","type":"CDM"},{"code":"0973","type":"RC"},{"code":"96405","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.0,"discounted_cash":597.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO CHEMO ADMIN; INTRALESIONAL OVER 7 LSNS","code_information":[{"code":"9730127","type":"CDM"},{"code":"0973","type":"RC"},{"code":"96406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.0,"discounted_cash":883.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 77293 PRO RESPIRATORY MOTION MGMT SIMULATION ADD ON","code_information":[{"code":"9730165","type":"CDM"},{"code":"0973","type":"RC"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":180.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC INC/REMOVE FB, SUBCUT, SIMPLE","code_information":[{"code":"9750001","type":"CDM"},{"code":"0975","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INCISION & DRAIN-COMPLEX;POST-OP WND INF","code_information":[{"code":"9750003","type":"CDM"},{"code":"0975","type":"RC"},{"code":"10180","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":308.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11010 PRO DEBRIDE W REMOVE FM FX/DISLC, SKIN & SUBQ TISSUES","code_information":[{"code":"9750004","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":620.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEBRIDE SKIN INC FB, TISSUE, MUS & BONE","code_information":[{"code":"9750005","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1829.0,"discounted_cash":1097.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEBRIDE SKIN/SQ TISSUE","code_information":[{"code":"9750008","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEBRIDE SKIN, SQ TISSUE & MUSCLE","code_information":[{"code":"9750009","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11043","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.0,"discounted_cash":753.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEBRIDE SKIN, SQ TISSUE & MUSCLE & BONE","code_information":[{"code":"9750010","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.0,"discounted_cash":633.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11730 PRO AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE","code_information":[{"code":"9750011","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":316.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPAIR OF NAIL BED","code_information":[{"code":"9750012","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INS NON-BIODEGRADEABLE DRUG DEL IMPLANT","code_information":[{"code":"9750013","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11981","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REM NON-BIODEGRADEABLE DRUG DEL IMPLANT","code_information":[{"code":"9750014","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11982","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":210.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REM W/ REINSERTION,NON-BIODEGRADE DRUG","code_information":[{"code":"9750015","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11983","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":347.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLOS, SCLP,SCL,TRK,EXTM<=2.5","code_information":[{"code":"9750016","type":"CDM"},{"code":"0975","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1114.0,"discounted_cash":668.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLO,SCLP,AXL,TRK,EXT,2.6-7.5","code_information":[{"code":"9750017","type":"CDM"},{"code":"0975","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1364.0,"discounted_cash":818.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLO,SCLP,AXL,TRK,EXT,7.6-12.5","code_information":[{"code":"9750018","type":"CDM"},{"code":"0975","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":1718.0,"discounted_cash":1030.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAYER CLO,SCLP,AXL,TRK,EXT,12.6-20","code_information":[{"code":"9750019","type":"CDM"},{"code":"0975","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2108.0,"discounted_cash":1264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COMP REP, SCALP,ARMS,LEGS 1.1CM-2.5CM","code_information":[{"code":"9750020","type":"CDM"},{"code":"0975","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1737.0,"discounted_cash":1042.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COMP REP, SCALP,ARMS,LEGS 2.6CM-7.5CM","code_information":[{"code":"9750021","type":"CDM"},{"code":"0975","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":2056.0,"discounted_cash":1233.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC COMPLEX SC,ARM,LG,EA ADD 5CM OR LESS","code_information":[{"code":"9750022","type":"CDM"},{"code":"0975","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1737.0,"discounted_cash":1042.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RP,CPLX,FH,CHK,MO,NK,G,HN,FT1.1-2.5CM","code_information":[{"code":"9750023","type":"CDM"},{"code":"0975","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1447.0,"discounted_cash":868.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RP,CPLX,FH,CK,MO,NK,G,HN,FT,2.6-7.5-975","code_information":[{"code":"9750024","type":"CDM"},{"code":"0975","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1737.0,"discounted_cash":1042.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RP,CPLX,FH,CK,MO,NK,G,HN,FT,ADD 5,<","code_information":[{"code":"9750025","type":"CDM"},{"code":"0975","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1737.0,"discounted_cash":1042.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14000 PRO TISSUE TRANSFER TRUNK<=10CM","code_information":[{"code":"9750026","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14001 PRO TISSUE TRANSFER TRUNK 10.1-30CM","code_information":[{"code":"9750027","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2065.0,"discounted_cash":1239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14020 PRO TISSUE TRANS SCALP,ARMS,LEG <=10 SQ CM","code_information":[{"code":"9750028","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14021 PRO TISSUE TRANS SCALP,ARMS,LEG10.1-30CM","code_information":[{"code":"9750029","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14021","type":"HCPCS"}],"standard_charges":[{"gross_charge":2385.0,"discounted_cash":1431.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14040 PRO TISSUE TRANS HEAD/HAND<=10CM","code_information":[{"code":"9750030","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14041 PRO TISSUE TRANS HEAD/HAND 10.1-30CM","code_information":[{"code":"9750031","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14041","type":"HCPCS"}],"standard_charges":[{"gross_charge":2598.0,"discounted_cash":1558.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14060 PRO TISSUE TRANS EYE/NOSE/EAR<=10CM","code_information":[{"code":"9750032","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14060","type":"HCPCS"}],"standard_charges":[{"gross_charge":2005.0,"discounted_cash":1203.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 14061 PRO TISSUE TRANS EYE/NOSE/EAR>30CM","code_information":[{"code":"9750033","type":"CDM"},{"code":"0975","type":"RC"},{"code":"14061","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1689.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRESSING CHANGE UNDER ANESTHESIA","code_information":[{"code":"9750036","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15852","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":337.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERT WIRE/PIN WITH SKELETAL TRACTION","code_information":[{"code":"9750045","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20650","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":337.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20670 PRO REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD)","code_information":[{"code":"9750048","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20670","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":331.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20680 PRO REMOVAL OF IMPLANT; DEEP","code_information":[{"code":"9750049","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1143.0,"discounted_cash":685.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC APP UNIPLANE,UNILATERAL, EXT FIX SYS-RT","code_information":[{"code":"9750050","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20690","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.0,"discounted_cash":553.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC APP UNIPLANE,UNILATERAL, EXT FIX SYS-LT","code_information":[{"code":"9750051","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20690","type":"HCPCS"}],"standard_charges":[{"gross_charge":923.0,"discounted_cash":553.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC APP UNILATERAL EXTERNAL FIXATION SYSTEM","code_information":[{"code":"9750052","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20692","type":"HCPCS"}],"standard_charges":[{"gross_charge":1726.0,"discounted_cash":1035.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ADJ/REV EXTERNAL FIXATION SYS REQ ANESTH","code_information":[{"code":"9750053","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20693","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL UNDER ANES, EXTERNAL FIXATION SYS","code_information":[{"code":"9750054","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20694","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.0,"discounted_cash":807.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BONE GRAFT, ANY DONOR AREA;MINOR/SMALL","code_information":[{"code":"9750055","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1834.0,"discounted_cash":1100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BONE GRAFT, ANY DONOR AREA;MAJOR/LARGE","code_information":[{"code":"9750056","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20902","type":"HCPCS"}],"standard_charges":[{"gross_charge":2376.0,"discounted_cash":1425.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ALLOGRAFT FOR SPINE SURGERY,MORSELIZED","code_information":[{"code":"9750058","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20930","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTH,W/DISKECTOMY CERVICAL BELOW C2","code_information":[{"code":"9750096","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22554","type":"HCPCS"}],"standard_charges":[{"gross_charge":9100.0,"discounted_cash":5460.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHRODESIS, POST/POSTOLATERAL-THORACIC","code_information":[{"code":"9750103","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22610","type":"HCPCS"}],"standard_charges":[{"gross_charge":3248.0,"discounted_cash":1948.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC POSTERIOR SEG INSTUM-3 TO 6 SEGMENTS","code_information":[{"code":"9750116","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22842","type":"HCPCS"}],"standard_charges":[{"gross_charge":1948.0,"discounted_cash":1168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX,CLAVICAL FX W/O MANIP-LT","code_information":[{"code":"9750125","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.0,"discounted_cash":874.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,CLAVICAL FX W/O MANIP-RT","code_information":[{"code":"9750126","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1458.0,"discounted_cash":874.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,CLAVICAL FX W/MANIP-LT","code_information":[{"code":"9750127","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,CLAVICAL FX W/MANIP-RT","code_information":[{"code":"9750128","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX CLAVICULAR FX  INCL INT FIXATION","code_information":[{"code":"9750129","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1912.0,"discounted_cash":1147.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX PROX HUMERAL FX WOR W/O FIXATION","code_information":[{"code":"9750130","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2986.0,"discounted_cash":1791.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX GRT HUMERAL TUBEROSITY FXW/O MAN","code_information":[{"code":"9750131","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23620","type":"HCPCS"}],"standard_charges":[{"gross_charge":672.0,"discounted_cash":403.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX GRT HUMERAL TUBEROSITY FXW/ MANP","code_information":[{"code":"9750132","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23625","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.0,"discounted_cash":545.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MANIP ELBOW UNDER ANESTHESIA","code_information":[{"code":"9750133","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.0,"discounted_cash":648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX,HUM SHFT FX W/OMANIP-LT","code_information":[{"code":"9750134","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.0,"discounted_cash":775.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,HUM SHFT FX W/OMANIP-RT","code_information":[{"code":"9750135","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.0,"discounted_cash":775.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX HUMERAL SHAFT FX W/PIT & SCREWS","code_information":[{"code":"9750136","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24515","type":"HCPCS"}],"standard_charges":[{"gross_charge":3495.0,"discounted_cash":2097.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TX HUMERAL SHAFT FX W/IMPLANT W W/O SC","code_information":[{"code":"9750137","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24516","type":"HCPCS"}],"standard_charges":[{"gross_charge":3461.0,"discounted_cash":2076.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX,SUP/TRAN HUM FX W/O MANIP-LT","code_information":[{"code":"9750138","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.0,"discounted_cash":852.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,SUP/TRAN HUM FX W/O MANIP-RT","code_information":[{"code":"9750139","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1421.0,"discounted_cash":852.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX SUP/TRANCON FX W/MAN W OR W/O TX","code_information":[{"code":"9750140","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24535","type":"HCPCS"}],"standard_charges":[{"gross_charge":2263.0,"discounted_cash":1357.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKELETAL FIX HUMERAL FX W/WO EXT","code_information":[{"code":"9750141","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24538","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.0,"discounted_cash":1113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX HUMERAL SUPRACOND/TRANS FX W/EXT","code_information":[{"code":"9750142","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24546","type":"HCPCS"}],"standard_charges":[{"gross_charge":4528.0,"discounted_cash":2716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX HUMERAL EPI FX INC INT FIXATION","code_information":[{"code":"9750143","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2093.0,"discounted_cash":1255.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD HUMERAL CONDY FX, MED/LAT W/OMAN-LT","code_information":[{"code":"9750144","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":1171.0,"discounted_cash":702.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD HUMERAL CONDY FX, MED/LAT W/OMAN-RT","code_information":[{"code":"9750145","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24576","type":"HCPCS"}],"standard_charges":[{"gross_charge":1171.0,"discounted_cash":702.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX MONTEG FX/DISLOC ELBOW W OR W/O","code_information":[{"code":"9750146","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4137.0,"discounted_cash":2482.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX, RAD HD/NK FX, W/O MAN-LT","code_information":[{"code":"9750147","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":354.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX, RAD HD/NK FX, W/O MAN-RT","code_information":[{"code":"9750148","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24650","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":354.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX ULNAR FX PROX END W OR W/O FIXAT","code_information":[{"code":"9750149","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24685","type":"HCPCS"}],"standard_charges":[{"gross_charge":2701.0,"discounted_cash":1620.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MANIPULATION,WRIST,W/ANESTHESIA","code_information":[{"code":"9750150","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25259","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":613.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP TEND/MUS FLEX ARM/WRIST PRIM SGL EA","code_information":[{"code":"9750151","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1796.0,"discounted_cash":1077.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP TEND/MUS FLEX ARM/WRIST 2ND, SGL EA","code_information":[{"code":"9750152","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25263","type":"HCPCS"}],"standard_charges":[{"gross_charge":5730.0,"discounted_cash":3438.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CAPSULORRHAPY WRIST OPEN, REP/TRAN/GRFT","code_information":[{"code":"9750153","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25320","type":"HCPCS"}],"standard_charges":[{"gross_charge":2539.0,"discounted_cash":1523.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPAIR RADIUS AND ULNA W/ AUTOGRAFT","code_information":[{"code":"9750154","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3656.0,"discounted_cash":2193.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX,RAD SHFT FX,W/O MANP-RT","code_information":[{"code":"9750155","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":376.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,RAD SHFT FX,W/O MANP-LT","code_information":[{"code":"9750156","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25500","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":376.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX RADIAL SHAFT FX/MANIP-RT","code_information":[{"code":"9750157","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":792.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX RADIAL SHAFT FX/MANIP-LT","code_information":[{"code":"9750158","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1321.0,"discounted_cash":792.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX ULNAR SHAFT FX W W/O FIXATION","code_information":[{"code":"9750159","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2736.0,"discounted_cash":1641.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX RAD & ULN FX W/O MAN-LT","code_information":[{"code":"9750160","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":372.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX RAD & ULN FX W/O MAN-RT","code_information":[{"code":"9750161","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25560","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.0,"discounted_cash":372.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,RADIAL/ULNA SHAFT FX W/MANIP-LT","code_information":[{"code":"9750162","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2036.0,"discounted_cash":1221.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,RADIAL/ULNA SHAFT FX W/MANIP-RT","code_information":[{"code":"9750163","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":2036.0,"discounted_cash":1221.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPN TX RAD&ULNA SHAFT FX W/ FIX-RAD/ULNA","code_information":[{"code":"9750164","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25574","type":"HCPCS"}],"standard_charges":[{"gross_charge":1799.0,"discounted_cash":1079.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPN TX RAD&ULNA SHAFT FX W/ FIX-RAD&ULNA","code_information":[{"code":"9750165","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25575","type":"HCPCS"}],"standard_charges":[{"gross_charge":2661.0,"discounted_cash":1596.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX DISTAL RADIAL FX SEP W/O MANP-RT","code_information":[{"code":"9750166","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX DISTAL RADIAL FX SEP W/O MANP-LT","code_information":[{"code":"9750167","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.0,"discounted_cash":400.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD, DIST RAD FX/EPIPHY, W/MAN-RT","code_information":[{"code":"9750168","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.0,"discounted_cash":772.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD, DIST RAD FX/EPIPHY, W/MAN-LT","code_information":[{"code":"9750169","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.0,"discounted_cash":772.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC SKELETAL FIX DISTAL RAD FX/EPIP SEP","code_information":[{"code":"9750170","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2030.0,"discounted_cash":1218.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX DISTAL RAD FX W/INTERN FIXATION","code_information":[{"code":"9750171","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1947.0,"discounted_cash":1168.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX DIST RAD FX-INT FIX 2 FRAG-RT","code_information":[{"code":"9750172","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":2800.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX DIST RAD FX-INT FIX 2 FRAG-LT","code_information":[{"code":"9750173","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25608","type":"HCPCS"}],"standard_charges":[{"gross_charge":2800.0,"discounted_cash":1680.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX, NAVICULAR FRACT,W/O MAN-RT","code_information":[{"code":"9750174","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":442.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX, NAVICULAR FRACT,W/O MAN-LT","code_information":[{"code":"9750175","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25622","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.0,"discounted_cash":442.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX CARPAL SCAPHOID FX W/INTERNL FIX","code_information":[{"code":"9750176","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25628","type":"HCPCS"}],"standard_charges":[{"gross_charge":2022.0,"discounted_cash":1213.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD CARP FX (NO NOV) MAN, EA-RT","code_information":[{"code":"9750177","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD CARP FX (NO NOV) MAN, EA-LT","code_information":[{"code":"9750178","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25630","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX CARPAL BONE FX EACH BONE","code_information":[{"code":"9750179","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1514.0,"discounted_cash":908.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TREATMENT ULNAR STYLOID FX RT","code_information":[{"code":"9750180","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":560.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TREATMENT ULNAR STYLOID FX LT","code_information":[{"code":"9750181","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25650","type":"HCPCS"}],"standard_charges":[{"gross_charge":934.0,"discounted_cash":560.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC SKELETAL FIX OF ULNAR STYLOID FX","code_information":[{"code":"9750182","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25651","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.0,"discounted_cash":744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TREAT OF ULNAR STYLOID FRACTURE","code_information":[{"code":"9750183","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1641.0,"discounted_cash":984.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TREATMENT OF LUNATE DISLOCATION","code_information":[{"code":"9750184","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25695","type":"HCPCS"}],"standard_charges":[{"gross_charge":1689.0,"discounted_cash":1013.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMPRESSIVE FASCIOTOMY, HAND","code_information":[{"code":"9750185","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2111.0,"discounted_cash":1266.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY,METACARPOPHALANGEAL JT,EA","code_information":[{"code":"9750186","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26075","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":519.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL OF IMPLANT FROM FINGER OR HAND","code_information":[{"code":"9750187","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26320","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.0,"discounted_cash":537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MANIP FINGER JOINT UNDER ANES EA JOINT","code_information":[{"code":"9750188","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26340","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":507.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP FLEX TENDON;W/O FREE GRAFT EA TEND","code_information":[{"code":"9750189","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26350","type":"HCPCS"}],"standard_charges":[{"gross_charge":2290.0,"discounted_cash":1374.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP FLEX TENDON;W FREE GRAFT EA TENDON","code_information":[{"code":"9750190","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26352","type":"HCPCS"}],"standard_charges":[{"gross_charge":2585.0,"discounted_cash":1551.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP FLEXOR TENDON- ZONE 2 PRIM W/O GRAFT","code_information":[{"code":"9750191","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26356","type":"HCPCS"}],"standard_charges":[{"gross_charge":2810.0,"discounted_cash":1686.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP EXT TENDON, FGR, PRM OR SEC,W/O GRFT","code_information":[{"code":"9750192","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1898.0,"discounted_cash":1138.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RECON COLLATERAL LIGAM I/P JT SGL EA JT","code_information":[{"code":"9750193","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26545","type":"HCPCS"}],"standard_charges":[{"gross_charge":1978.0,"discounted_cash":1186.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD CARP FX,SNG W/O MAN, EA-RT","code_information":[{"code":"9750194","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":555.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD CARP FX,SNG W/O MAN, EA-LT","code_information":[{"code":"9750195","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":555.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD CARP FX FX, SGN W/ MAN, EA-LT","code_information":[{"code":"9750196","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":841.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD CARP FX FX, SGN W/ MAN, EA-RT","code_information":[{"code":"9750197","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.0,"discounted_cash":841.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC SKELETAL FIXATE OF METACARPAL FX EA","code_information":[{"code":"9750198","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26608","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":786.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN METACARPAL FX W OR W/O MAN","code_information":[{"code":"9750199","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26615","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":858.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX CARPMETACARPAL DISLOC REQ ANESTH","code_information":[{"code":"9750200","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1416.0,"discounted_cash":849.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX CARPOMETACARPAL DISLOC EA JT","code_information":[{"code":"9750201","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26685","type":"HCPCS"}],"standard_charges":[{"gross_charge":1544.0,"discounted_cash":926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD SHAFT FX PRX/MID FNG W/O MAN","code_information":[{"code":"9750202","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26720","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":364.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD SHAFT FX PRX/MID FGR/THUMB W/MAN","code_information":[{"code":"9750203","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1200.0,"discounted_cash":720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKEL FIX PHALANGEAL SHT FX W.MANIP","code_information":[{"code":"9750204","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26727","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"discounted_cash":1038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX PHALANGEAL SHT FX W OR W/O MAN","code_information":[{"code":"9750205","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26735","type":"HCPCS"}],"standard_charges":[{"gross_charge":1775.0,"discounted_cash":1065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX DIS PHALAN FX,FGR/THUMB W/O MAN","code_information":[{"code":"9750206","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26750","type":"HCPCS"}],"standard_charges":[{"gross_charge":627.0,"discounted_cash":376.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX DIS PHALAN FX,FGR/THUMB W MAN","code_information":[{"code":"9750207","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":522.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKELETAL FIX DIST PHALANGEAL FX EA","code_information":[{"code":"9750208","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26756","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":604.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHRODESIS METACARP JT W OR W/O INT FIX","code_information":[{"code":"9750209","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26852","type":"HCPCS"}],"standard_charges":[{"gross_charge":2065.0,"discounted_cash":1239.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AMP FGR/THMB;ANY JOINT SGL W/CLOS","code_information":[{"code":"9750210","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26951","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":942.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY HIP,INC EXP/REM LOOSE OR FB","code_information":[{"code":"9750211","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27033","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":1476.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVE FOREIGN BODY, PELVIS OR HIP, DEEP","code_information":[{"code":"9750212","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27087","type":"HCPCS"}],"standard_charges":[{"gross_charge":2362.0,"discounted_cash":1417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX ILIAC SPINE OR WING W/INT FIX","code_information":[{"code":"9750215","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2180.0,"discounted_cash":1308.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKEL FIX PELVIC BONE FX &/OR DISLC","code_information":[{"code":"9750216","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27216","type":"HCPCS"}],"standard_charges":[{"gross_charge":4545.0,"discounted_cash":2727.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX POST PELVC RING FX/DISL W INT FX","code_information":[{"code":"9750217","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27218","type":"HCPCS"}],"standard_charges":[{"gross_charge":5827.0,"discounted_cash":3496.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX ACETABULUM FX W/O MANIP-RT","code_information":[{"code":"9750218","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1265.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX ACETABULUM FX W/O MANIP-LT","code_information":[{"code":"9750219","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1265.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX ACETABULAR FX W/INTERN FIXATION","code_information":[{"code":"9750220","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27227","type":"HCPCS"}],"standard_charges":[{"gross_charge":7097.0,"discounted_cash":4258.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKELETL FIX FEM FX, PROX END, NECK","code_information":[{"code":"9750221","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27235","type":"HCPCS"}],"standard_charges":[{"gross_charge":2468.0,"discounted_cash":1480.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX FEMORAL FX WITHOUT MANIP-LT","code_information":[{"code":"9750222","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.0,"discounted_cash":719.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX FEMORAL FX WITHOUT MANIP-RT","code_information":[{"code":"9750223","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.0,"discounted_cash":719.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TX FEMORAL FX W/IMPLANT W OR W/O SCREWS","code_information":[{"code":"9750224","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27245","type":"HCPCS"}],"standard_charges":[{"gross_charge":6211.0,"discounted_cash":3726.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX HIP DISLOC,W/O INTERNAL FIXATION","code_information":[{"code":"9750225","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27253","type":"HCPCS"}],"standard_charges":[{"gross_charge":3915.0,"discounted_cash":2349.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MANIPULATION HIP JT REQUIRING GEN ANESTH","code_information":[{"code":"9750226","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27275","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":410.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC I & D DEEP ABCESS BURSA/HEMATOMA","code_information":[{"code":"9750227","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2511.0,"discounted_cash":1506.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INC, DEEP W/OPN BONE CORTEX,FEMR,KNEE-RT","code_information":[{"code":"9750228","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1871.0,"discounted_cash":1122.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INC, DEEP W/OPN BONE CORTEX,FEMR,KNEE-LT","code_information":[{"code":"9750229","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1871.0,"discounted_cash":1122.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE W/EXPLORATION/REM OF FB","code_information":[{"code":"9750230","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27310","type":"HCPCS"}],"standard_charges":[{"gross_charge":2067.0,"discounted_cash":1240.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY KNEE W/JT EXP,BX OR REM OF FB","code_information":[{"code":"9750231","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27331","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.0,"discounted_cash":807.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY WITH MENISCUS REPAIR, KNEE","code_information":[{"code":"9750232","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1811.0,"discounted_cash":1086.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LATERAL RETINACULAR RELEASE, OPEN","code_information":[{"code":"9750233","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27425","type":"HCPCS"}],"standard_charges":[{"gross_charge":1255.0,"discounted_cash":753.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTEOTOMY PROX TIB INC EXC BEFORE EPIPH","code_information":[{"code":"9750234","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27455","type":"HCPCS"}],"standard_charges":[{"gross_charge":2806.0,"discounted_cash":1683.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTEOTOMY PROX TIB INC EXC AFTER EPIPH","code_information":[{"code":"9750235","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27457","type":"HCPCS"}],"standard_charges":[{"gross_charge":2896.0,"discounted_cash":1737.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD CONDYLAR FENORAL FX W/OMAN","code_information":[{"code":"9750236","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27501","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.0,"discounted_cash":1212.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX,FEMORAL SHAFT FX,W/MAN-LT","code_information":[{"code":"9750237","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":2143.0,"discounted_cash":1285.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX,FEMORAL SHAFT FX,W/MAN-RT","code_information":[{"code":"9750238","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":2143.0,"discounted_cash":1285.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX FEM FX W/IMPLANT W OR W/O FIXAT","code_information":[{"code":"9750239","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27506","type":"HCPCS"}],"standard_charges":[{"gross_charge":5485.0,"discounted_cash":3291.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27508 PRO CLSD FEMOR FX, DIST MEDIAL/LAT CONDYLE WO MANIP - LT","code_information":[{"code":"9750240","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":838.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27508 PRO CLSD FEMOR FX, DIST MEDIAL/LAT CONDYLE WO MANIP - RT","code_information":[{"code":"9750241","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27508","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.0,"discounted_cash":838.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX FEMORAL FX,DIST END WITH MANIP","code_information":[{"code":"9750242","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX FEM FX W/INTERCONDYLAR EXTENSION","code_information":[{"code":"9750243","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27513","type":"HCPCS"}],"standard_charges":[{"gross_charge":5743.0,"discounted_cash":3445.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX FEMORAL FX W OR W/O FIXATION","code_information":[{"code":"9750244","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27514","type":"HCPCS"}],"standard_charges":[{"gross_charge":5537.0,"discounted_cash":3322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX PATELLAR FX W/INTERNAL FIXATION","code_information":[{"code":"9750245","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27524","type":"HCPCS"}],"standard_charges":[{"gross_charge":3026.0,"discounted_cash":1815.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX TIBIAL FX, PROX W/O MANIP-LT","code_information":[{"code":"9750246","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":268.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIBIAL FX, PROX W/O MANIP-RT","code_information":[{"code":"9750247","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27530","type":"HCPCS"}],"standard_charges":[{"gross_charge":448.0,"discounted_cash":268.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIB FX W OR W/O MAN W/ TRAC-LT","code_information":[{"code":"9750248","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":848.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIB FX W OR W/O MAN W/ TRAC-RT","code_information":[{"code":"9750249","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27532","type":"HCPCS"}],"standard_charges":[{"gross_charge":1414.0,"discounted_cash":848.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX TIBIAL FX PROX W OR W/O FIXATION","code_information":[{"code":"9750250","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27535","type":"HCPCS"}],"standard_charges":[{"gross_charge":3866.0,"discounted_cash":2319.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX TIBIAL FX PROX;BICONDYLAR W/FIX","code_information":[{"code":"9750251","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27536","type":"HCPCS"}],"standard_charges":[{"gross_charge":3644.0,"discounted_cash":2186.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MANIP KNEE JOINT UNDER GENERAL ANESTHES","code_information":[{"code":"9750252","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27570","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DISARTICULATION AT KNEE RT","code_information":[{"code":"9750253","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27598","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.0,"discounted_cash":1372.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DISARTICULATION AT KNEE LT","code_information":[{"code":"9750254","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27598","type":"HCPCS"}],"standard_charges":[{"gross_charge":2288.0,"discounted_cash":1372.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOMP FASCIOTOMY ANT/LAT & POST COMP-LT","code_information":[{"code":"9750255","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27602","type":"HCPCS"}],"standard_charges":[{"gross_charge":4613.0,"discounted_cash":2767.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOMP FASCIOTOMY ANT/LAT & POST COMP-RT","code_information":[{"code":"9750256","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27602","type":"HCPCS"}],"standard_charges":[{"gross_charge":4613.0,"discounted_cash":2767.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I & D LEG/ANKLE ABCESS/HEMATOMA","code_information":[{"code":"9750257","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27603","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":654.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTEOTOMY;TIBIA","code_information":[{"code":"9750258","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27705","type":"HCPCS"}],"standard_charges":[{"gross_charge":2094.0,"discounted_cash":1256.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTEOTOMY;FIBULA","code_information":[{"code":"9750259","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27707","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":630.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTEOTOMY;TIBIA & FIBULA","code_information":[{"code":"9750260","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27709","type":"HCPCS"}],"standard_charges":[{"gross_charge":2896.0,"discounted_cash":1737.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC RPR NON-UNION/MALUNION TIBIA W/O GRFT-LT","code_information":[{"code":"9750261","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27720","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.0,"discounted_cash":2008.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC RPR NON-UNION/MALUNION TIBIA W/O GRFT-RT","code_information":[{"code":"9750262","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27720","type":"HCPCS"}],"standard_charges":[{"gross_charge":3348.0,"discounted_cash":2008.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC RPR TIBIA NONUNION W/ILIAC OR AUTOGFT-LT","code_information":[{"code":"9750263","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27724","type":"HCPCS"}],"standard_charges":[{"gross_charge":5992.0,"discounted_cash":3595.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC RPR TIBIA NONUNION W/ILIAC OR AUTOGFT-RT","code_information":[{"code":"9750264","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27724","type":"HCPCS"}],"standard_charges":[{"gross_charge":5992.0,"discounted_cash":3595.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIBIAL SHAFT FX W/O MANIP-RT","code_information":[{"code":"9750265","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":541.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIBIAL SHAFT FX W/O MANIP-LT","code_information":[{"code":"9750266","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":541.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIBIAL SHAFT FX W MANIP-RT","code_information":[{"code":"9750267","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1389.0,"discounted_cash":833.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIBIAL SHAFT FX W MANIP-LT","code_information":[{"code":"9750268","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1389.0,"discounted_cash":833.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERCUTAN SKELETAL FIX TIBIAL SHAFT FX","code_information":[{"code":"9750269","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27756","type":"HCPCS"}],"standard_charges":[{"gross_charge":2176.0,"discounted_cash":1305.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX TIBIAL SHFT FX W OR W/O CERC-RT","code_information":[{"code":"9750270","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27758","type":"HCPCS"}],"standard_charges":[{"gross_charge":3356.0,"discounted_cash":2013.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX TIBIAL SHFT FX W OR W/O CERC-LT","code_information":[{"code":"9750271","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27758","type":"HCPCS"}],"standard_charges":[{"gross_charge":3356.0,"discounted_cash":2013.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TX TIB SHAFT FX BY IMP W OR W/O SCREWS","code_information":[{"code":"9750272","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27759","type":"HCPCS"}],"standard_charges":[{"gross_charge":4022.0,"discounted_cash":2413.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27760 PRO CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; W/O MANIPULATION-LT","code_information":[{"code":"9750273","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":488.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27760 PRO CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; W/O MANIPULATION-RT","code_information":[{"code":"9750274","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27760","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":488.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27780 PRO CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; W/O MANIP-RT","code_information":[{"code":"9750275","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27780 PRO CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; W/O MANIP-LT","code_information":[{"code":"9750276","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27780","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD FIBULA FX W/MANIP LT","code_information":[{"code":"9750277","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1778.0,"discounted_cash":1066.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD FIBULA FX W/MANIP RT","code_information":[{"code":"9750278","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1778.0,"discounted_cash":1066.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN FIBULA FX W OR W/O MANIP","code_information":[{"code":"9750279","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27784","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1726.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27786 PRO CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE; W/O MANIPULATION - RT","code_information":[{"code":"9750280","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":936.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27786 PRO CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE; W/O MANIPULATION - LT","code_information":[{"code":"9750281","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27786","type":"HCPCS"}],"standard_charges":[{"gross_charge":1561.0,"discounted_cash":936.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX DISTAL FIBULAR FX W OR W/O FIXAT","code_information":[{"code":"9750282","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27792","type":"HCPCS"}],"standard_charges":[{"gross_charge":2408.0,"discounted_cash":1444.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX BIMALLEOLAR AKLE FX W/O MANIP-RT","code_information":[{"code":"9750283","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.0,"discounted_cash":745.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX BIMALLEOLAR AKLE FX W/O MANIP-LT","code_information":[{"code":"9750284","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1242.0,"discounted_cash":745.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD BIMALLEOLAR ANKLE FX, W/MAN","code_information":[{"code":"9750285","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1810.0,"discounted_cash":1086.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPN TX BIMALLEOLAR ANKLE FX W OR W/O FIX","code_information":[{"code":"9750286","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27814","type":"HCPCS"}],"standard_charges":[{"gross_charge":3200.0,"discounted_cash":1920.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX TRIMALLEOLAR ANKLE FX W/O MAN-RT","code_information":[{"code":"9750287","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":455.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TRIMALLEOLAR ANKLE FX W/O MAN-LT","code_information":[{"code":"9750288","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27816","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.0,"discounted_cash":455.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TRIMALLEOLAR ANKLE FX W/MANIP-RT","code_information":[{"code":"9750289","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1156.0,"discounted_cash":693.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TRIMALLEOLAR ANKLE FX W/MANIP-LT","code_information":[{"code":"9750290","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1156.0,"discounted_cash":693.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX TRIMALLEOLAR ANK FX W OR W/O FIX","code_information":[{"code":"9750291","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27822","type":"HCPCS"}],"standard_charges":[{"gross_charge":3547.0,"discounted_cash":2128.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX FX DIST TIBIA W OR W/O ANES-RT","code_information":[{"code":"9750292","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":487.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX FX DIST TIBIA W OR W/O ANES-LT","code_information":[{"code":"9750293","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27824","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.0,"discounted_cash":487.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIBIA FX W/O MANIPULATION-RT","code_information":[{"code":"9750294","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":734.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TIBIA FX W/O  MANIPULATION-LT","code_information":[{"code":"9750295","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27825","type":"HCPCS"}],"standard_charges":[{"gross_charge":1224.0,"discounted_cash":734.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPN TX FX DISTAL TIBIA FIX FIBULA ONLY","code_information":[{"code":"9750296","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27826","type":"HCPCS"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1698.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPN TX FX DISTAL TIBIA FIX TIBIA ONLY","code_information":[{"code":"9750297","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27827","type":"HCPCS"}],"standard_charges":[{"gross_charge":4416.0,"discounted_cash":2649.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPN TX FX OF BOTH TIBIA AND FIBULA","code_information":[{"code":"9750298","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27828","type":"HCPCS"}],"standard_charges":[{"gross_charge":4984.0,"discounted_cash":2990.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX DISTAL TIBIOFIBULAR JT W W/O FIX","code_information":[{"code":"9750299","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27829","type":"HCPCS"}],"standard_charges":[{"gross_charge":1974.0,"discounted_cash":1184.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX ANKLE DISLOC REQ ANES W W/O FIX","code_information":[{"code":"9750300","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":2028.0,"discounted_cash":1216.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MANIPULATION ANKLE UNDER GENERAL ANES","code_information":[{"code":"9750301","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27860","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":430.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AMPUTATION LEG,THROUGH TIBA & FIBULA RT","code_information":[{"code":"9750302","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27880","type":"HCPCS"}],"standard_charges":[{"gross_charge":3736.0,"discounted_cash":2241.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION LEG,THROUGH TIBA & FIBULA LT","code_information":[{"code":"9750303","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27880","type":"HCPCS"}],"standard_charges":[{"gross_charge":3736.0,"discounted_cash":2241.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMMPUTATION LEG,THRU TIB/FIB W/CAST LT","code_information":[{"code":"9750304","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27881","type":"HCPCS"}],"standard_charges":[{"gross_charge":3705.0,"discounted_cash":2223.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMMPUTATION LEG,THRU TIB/FIB W/CAST RT","code_information":[{"code":"9750305","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27881","type":"HCPCS"}],"standard_charges":[{"gross_charge":3705.0,"discounted_cash":2223.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OSTECTOMY, COMP EXC FIRST METATARSAL HD","code_information":[{"code":"9750306","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1278.0,"discounted_cash":766.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTECTOMY, COMP EXC OTHER METATARSAL HD","code_information":[{"code":"9750307","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28112","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":534.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTECTOMY, COMP EXC 5TH METATARSAL HEAD","code_information":[{"code":"9750308","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28113","type":"HCPCS"}],"standard_charges":[{"gross_charge":1132.0,"discounted_cash":679.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28400 PRO CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION - RT","code_information":[{"code":"9750309","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":786.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28400 PRO CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION - LT","code_information":[{"code":"9750310","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":786.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX CALCANEAL FX W/ MANIPULATION RT","code_information":[{"code":"9750311","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":629.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX CALCANEAL FX W/ MANIPULATION LT","code_information":[{"code":"9750312","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.0,"discounted_cash":629.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC SKEL FIX OF CALCANEAL FX W/MAN LT","code_information":[{"code":"9750313","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.0,"discounted_cash":1150.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC SKEL FIX OF CALCANEAL FX W/MAN RT","code_information":[{"code":"9750314","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28406","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.0,"discounted_cash":1150.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX CALCANEAL FX W OR W/O FIXATION","code_information":[{"code":"9750315","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28415","type":"HCPCS"}],"standard_charges":[{"gross_charge":4828.0,"discounted_cash":2896.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX CALCANEAL FX W/PRIM BONE GRAFT","code_information":[{"code":"9750316","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28420","type":"HCPCS"}],"standard_charges":[{"gross_charge":3315.0,"discounted_cash":1989.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28430 PRO CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION - RT","code_information":[{"code":"9750317","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":786.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28430 PRO CLOSED TREATMENT OF TALUS FRACTURE; WITHOUT MANIPULATION - LT","code_information":[{"code":"9750318","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1310.0,"discounted_cash":786.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX TALUS FX W OR W/O INT/EXT FIXATE","code_information":[{"code":"9750319","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28445","type":"HCPCS"}],"standard_charges":[{"gross_charge":4450.0,"discounted_cash":2670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28450 PRO TX TARSAL BONE FRACTURE W/O MANIP EACH","code_information":[{"code":"9750320","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28450","type":"HCPCS"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX TARSAL BONE FX W OR W/O FIX EACH","code_information":[{"code":"9750321","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28465","type":"HCPCS"}],"standard_charges":[{"gross_charge":2177.0,"discounted_cash":1306.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28470 PRO CLOSED TREATMENT OF METETARSAL FRACTURE; WITHOUT MANIPULATION, EACH","code_information":[{"code":"9750322","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28470","type":"HCPCS"}],"standard_charges":[{"gross_charge":1040.0,"discounted_cash":624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28475 PRO CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH","code_information":[{"code":"9750323","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":724.0,"discounted_cash":434.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKELETAL FIX METATARSAL FX W/MANIP","code_information":[{"code":"9750324","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28476","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":537.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX METATARSAL FX WITH OR W/O FIX","code_information":[{"code":"9750325","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28485","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.0,"discounted_cash":1486.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKELETAL FIX OF FX OF GRT TOE W/MAN","code_information":[{"code":"9750326","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28496","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.0,"discounted_cash":363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX TARSAL BONE DISLOC W OR W/O FIX","code_information":[{"code":"9750327","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1968.0,"discounted_cash":1180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX TARSOMETRAT JT DISLOC;REQ ANES","code_information":[{"code":"9750328","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28605","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.0,"discounted_cash":468.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC TX TARSOMETATARSAL JT W/OANES-LT","code_information":[{"code":"9750329","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28606","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.0,"discounted_cash":3205.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC TX TARSOMETATARSAL JT W/OANES-RT","code_information":[{"code":"9750330","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28606","type":"HCPCS"}],"standard_charges":[{"gross_charge":5343.0,"discounted_cash":3205.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX TARSOMETATARSAL JNT DISLOCATION","code_information":[{"code":"9750331","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2572.0,"discounted_cash":1543.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AMPUTATION, METATARSAL,W/TOE SINGLE","code_information":[{"code":"9750332","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28810","type":"HCPCS"}],"standard_charges":[{"gross_charge":1208.0,"discounted_cash":724.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AMPUTATION, TOE;METATARSOPHALANGEAL JT","code_information":[{"code":"9750333","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28820","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC AMPUTATION, TOE;INTERPHALANGEAL JOINT","code_information":[{"code":"9750334","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28825","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.0,"discounted_cash":467.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29515 PRO APPL SHORT LEG SPLINT(CALF/FOOT)-LT","code_information":[{"code":"9750335","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29515 PRO APPL SHORT LEG SPLINT(CALF/FOOT)-RT","code_information":[{"code":"9750336","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR BLOOD VESSEL, DIRECT; UPPER EXT","code_information":[{"code":"9750340","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.0,"discounted_cash":1283.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP BLOOD VESSEL, DIRECT; HAND, FINGER","code_information":[{"code":"9750341","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35207","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.0,"discounted_cash":1145.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TWIST DRLL HOLE-VNT/SUB IMPL CTH/ICP","code_information":[{"code":"9750355","type":"CDM"},{"code":"0975","type":"RC"},{"code":"61107","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.0,"discounted_cash":844.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC BURR HOLE(S) OR TREPHINE; W/BX OF BRAIN","code_information":[{"code":"9750358","type":"CDM"},{"code":"0975","type":"RC"},{"code":"61140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3275.0,"discounted_cash":1965.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRANIOTOMY-EVAC HEMA-SUPRA;EXTRA/SUB","code_information":[{"code":"9750368","type":"CDM"},{"code":"0975","type":"RC"},{"code":"61312","type":"HCPCS"}],"standard_charges":[{"gross_charge":5368.0,"discounted_cash":3220.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRANIOTOMY-DRN ABCESS INTRACRN;SUPRA","code_information":[{"code":"9750373","type":"CDM"},{"code":"0975","type":"RC"},{"code":"61320","type":"HCPCS"}],"standard_charges":[{"gross_charge":4901.0,"discounted_cash":2940.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRAINIECTOMY EXC BRAIN TUMOR,NOT MENINGI","code_information":[{"code":"9750389","type":"CDM"},{"code":"0975","type":"RC"},{"code":"61510","type":"HCPCS"}],"standard_charges":[{"gross_charge":5604.0,"discounted_cash":3362.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRAINIECTOMY BRAIN TUMOR, NOT MENINGIOMA","code_information":[{"code":"9750393","type":"CDM"},{"code":"0975","type":"RC"},{"code":"61518","type":"HCPCS"}],"standard_charges":[{"gross_charge":5381.0,"discounted_cash":3228.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ELEV DEPRESS SKULL FX-COMPOUND EXTR","code_information":[{"code":"9750448","type":"CDM"},{"code":"0975","type":"RC"},{"code":"62005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2799.0,"discounted_cash":1679.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CRANIOPLASTY SKULL DEFECT UP TO 5CM","code_information":[{"code":"9750456","type":"CDM"},{"code":"0975","type":"RC"},{"code":"62140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.0,"discounted_cash":1333.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP/REV CSF SHUNT,VALVE/CATH IN SYSTEM","code_information":[{"code":"9750474","type":"CDM"},{"code":"0975","type":"RC"},{"code":"62230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1630.0,"discounted_cash":978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPINAL PUNCT-DRAIN OF CSF-CATH/NDL","code_information":[{"code":"9750479","type":"CDM"},{"code":"0975","type":"RC"},{"code":"62272","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LAMI, FAC/FOR UN/BL W/DC SC,SNG VTSG;CRV","code_information":[{"code":"9750496","type":"CDM"},{"code":"0975","type":"RC"},{"code":"63045","type":"HCPCS"}],"standard_charges":[{"gross_charge":10059.0,"discounted_cash":6035.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DISKECTOMY,ANT W/DECOM CERVICAL, SGL","code_information":[{"code":"9750507","type":"CDM"},{"code":"0975","type":"RC"},{"code":"63075","type":"HCPCS"}],"standard_charges":[{"gross_charge":2483.0,"discounted_cash":1489.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC VERT CORPECTOMY, W/DECOMP SPINE,CERVICAL","code_information":[{"code":"9750511","type":"CDM"},{"code":"0975","type":"RC"},{"code":"63081","type":"HCPCS"}],"standard_charges":[{"gross_charge":4487.0,"discounted_cash":2692.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEUROPLASTY/TRANSPOSITION;CRANIAL NERVE","code_information":[{"code":"9750561","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64716","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.0,"discounted_cash":824.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64718 PRO NEUROPLASTY/TRANSPO ULNAR NERVE AT ELBOW","code_information":[{"code":"9750562","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2914.0,"discounted_cash":1748.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEUROPLASTY;ULNAR NERVE AT WRIST","code_information":[{"code":"9750563","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64719","type":"HCPCS"}],"standard_charges":[{"gross_charge":2131.0,"discounted_cash":1278.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEUROPLASTY;MEDIAN NRV AT CARPAL TUNNEL","code_information":[{"code":"9750564","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64721","type":"HCPCS"}],"standard_charges":[{"gross_charge":1548.0,"discounted_cash":928.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMPRESSION;UNSPECIFIED NERVE(S)","code_information":[{"code":"9750565","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64722","type":"HCPCS"}],"standard_charges":[{"gross_charge":891.0,"discounted_cash":534.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64726 PRO DECOMPRESSION PLANTAR DIGITAL NERVE","code_information":[{"code":"9750566","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64726","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.0,"discounted_cash":477.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUT DIG NERVE, HAND OR FOOT, ONE NERVE","code_information":[{"code":"9750568","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64831","type":"HCPCS"}],"standard_charges":[{"gross_charge":2313.0,"discounted_cash":1387.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUT DIG NERVE, HAND OR FOOT, EA ADD NRV","code_information":[{"code":"9750569","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64832","type":"HCPCS"}],"standard_charges":[{"gross_charge":1164.0,"discounted_cash":698.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SELECT DEBRIDEMENT FIRST 20 SQ CM OR <","code_information":[{"code":"9750575","type":"CDM"},{"code":"0975","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SELECT DEBRIDEMENT EA ADD 20 SQ CM","code_information":[{"code":"9750576","type":"CDM"},{"code":"0975","type":"RC"},{"code":"97598","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL OF POST NON-SEG INSTRUMENTATION","code_information":[{"code":"9750589","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22850","type":"HCPCS"}],"standard_charges":[{"gross_charge":5169.0,"discounted_cash":3101.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP INTER WND SCLP,AX TRNK 2.5 CM OR <","code_information":[{"code":"9750591","type":"CDM"},{"code":"0975","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":872.0,"discounted_cash":523.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLIT-THICK AUTOGRAFT 1ST 100 SQ CM","code_information":[{"code":"9750593","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2505.0,"discounted_cash":1503.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLIT-THICK AUTOGRAFT EA ADD 100 SQ CM","code_information":[{"code":"9750594","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15101","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":378.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLS TX,NAVICULAR FRACT,WITH MAN-LT","code_information":[{"code":"9750595","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":774.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLS TX,NAVICULAR FRACT,WITH MAN-RT","code_information":[{"code":"9750596","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25624","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":774.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD CARP FX (NO NOV) WITH MAN, EA-RT-PHY","code_information":[{"code":"9750597","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":729.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD CARP FX (NO NOV) WITH MAN, EA-LT-PHY","code_information":[{"code":"9750598","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1215.0,"discounted_cash":729.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX INTERPLHALANGEAL JT DISLOC W/FIX","code_information":[{"code":"9750599","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26785","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":987.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPAIR PRIMARY DISRUPTED LIGAMENT, ANKLE","code_information":[{"code":"9750600","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":1571.0,"discounted_cash":942.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX MED MALLEOLUS FX, W INT FIX","code_information":[{"code":"9750601","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27766","type":"HCPCS"}],"standard_charges":[{"gross_charge":1937.0,"discounted_cash":1162.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX ANKLE DISLOC W REPAIR INT OR EXT FIX","code_information":[{"code":"9750602","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27848","type":"HCPCS"}],"standard_charges":[{"gross_charge":2688.0,"discounted_cash":1612.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEUROPLASTY;DIGITAL OR OR 2 SAME DIGIT","code_information":[{"code":"9750603","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64702","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.0,"discounted_cash":909.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX ACETABULAR FX 2 COL FX W/ FIX","code_information":[{"code":"9750605","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27228","type":"HCPCS"}],"standard_charges":[{"gross_charge":6822.0,"discounted_cash":4093.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL POST NONSEG INSTR","code_information":[{"code":"9750610","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22850","type":"HCPCS"}],"standard_charges":[{"gross_charge":2526.0,"discounted_cash":1515.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC APP UNILATERAT EXT FIX W/CSD","code_information":[{"code":"9750611","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20696","type":"HCPCS"}],"standard_charges":[{"gross_charge":3327.0,"discounted_cash":1996.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20245 PRO BONE BX,OPEN,EXCISION-DEEP","code_information":[{"code":"9750612","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20245","type":"HCPCS"}],"standard_charges":[{"gross_charge":2032.0,"discounted_cash":1219.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 10060 PRO I&D ABCESS - SIMPLE/SINGLE","code_information":[{"code":"9750613","type":"CDM"},{"code":"0975","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXP W REM DEEP FB, ARM OR WRIST RT","code_information":[{"code":"9750614","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":827.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXP W REM DEEP FB, ARM OR WRIST LT","code_information":[{"code":"9750615","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25248","type":"HCPCS"}],"standard_charges":[{"gross_charge":1379.0,"discounted_cash":827.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX ANKLE DISLOC W W/O FIXATION","code_information":[{"code":"9750616","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27846","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":998.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRAINAGE OF FINGER ABCESS; SIMPLE","code_information":[{"code":"9750618","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DRAINAGE OF FINGER ABCESS; COMPL","code_information":[{"code":"9750619","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":3323.0,"discounted_cash":1993.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMP FASCIOTOMY,LEG,ANT COMPART W/DEBRIDE","code_information":[{"code":"9750620","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27892","type":"HCPCS"}],"standard_charges":[{"gross_charge":8355.0,"discounted_cash":5013.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMP FASCIOTOMY,LEG,POST COMPART W/DEBRIDE","code_information":[{"code":"9750621","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27893","type":"HCPCS"}],"standard_charges":[{"gross_charge":8355.0,"discounted_cash":5013.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMP FASCIOTOMY,LEG,ANT&LAT COMPART W/DEBRIDE","code_information":[{"code":"9750622","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27894","type":"HCPCS"}],"standard_charges":[{"gross_charge":8355.0,"discounted_cash":5013.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROSCOPY, KNEE, SURG; FOR INFCT, LAV&DRAIN","code_information":[{"code":"9750623","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29871","type":"HCPCS"}],"standard_charges":[{"gross_charge":7700.0,"discounted_cash":4620.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROSCOPY, KNEE, SURGICAL; W/ RELEASE","code_information":[{"code":"9750624","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29873","type":"HCPCS"}],"standard_charges":[{"gross_charge":7868.0,"discounted_cash":4720.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROSCOPY, KNEE, SURGICAL; REM  LOOSE BODY","code_information":[{"code":"9750625","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7700.0,"discounted_cash":4620.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROSCOPY, KNEE, SURG; ABRASION ARTHROPLASTY","code_information":[{"code":"9750626","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29879","type":"HCPCS"}],"standard_charges":[{"gross_charge":7700.0,"discounted_cash":4620.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPN TX INCONDY SPINE FX KNEE W/INT FX","code_information":[{"code":"9750627","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27540","type":"HCPCS"}],"standard_charges":[{"gross_charge":5634.0,"discounted_cash":3380.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPN TX DIS RAD-INT FIX 3/MORE FRG-RT","code_information":[{"code":"9750629","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25609","type":"HCPCS"}],"standard_charges":[{"gross_charge":3452.0,"discounted_cash":2071.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPN TX DIS RAD-INT FIX 3/MORE FRG-LT","code_information":[{"code":"9750630","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25609","type":"HCPCS"}],"standard_charges":[{"gross_charge":3452.0,"discounted_cash":2071.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPN TX RAD SHAFT FX INC INT FIX-RT","code_information":[{"code":"9750631","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25515","type":"HCPCS"}],"standard_charges":[{"gross_charge":2211.0,"discounted_cash":1326.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPN TX RAD SHAFT FX INC INT FIX-LT","code_information":[{"code":"9750632","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25515","type":"HCPCS"}],"standard_charges":[{"gross_charge":2211.0,"discounted_cash":1326.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPN TX RAD HD/NECK FX W/ HD PROS REP-RT","code_information":[{"code":"9750633","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24666","type":"HCPCS"}],"standard_charges":[{"gross_charge":2433.0,"discounted_cash":1459.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPN TX RAD HD/NECK FX W/ HD PROS REP-LT","code_information":[{"code":"9750634","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24666","type":"HCPCS"}],"standard_charges":[{"gross_charge":2433.0,"discounted_cash":1459.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX PROX HUMERAL FX W/O MANIP-RT","code_information":[{"code":"9750635","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":655.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX PROX HUMERAL FX W/O MANIP-LT","code_information":[{"code":"9750636","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":655.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX PROX HUMERAL FX W/ MANIP-RT","code_information":[{"code":"9750637","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":889.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX PROX HUMERAL FX W/ MANIP-LT","code_information":[{"code":"9750638","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.0,"discounted_cash":889.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX TARSAL BONE W/O ANES","code_information":[{"code":"9750639","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":528.0,"discounted_cash":316.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX TARSAL BONE W/ ANES","code_information":[{"code":"9750640","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28545","type":"HCPCS"}],"standard_charges":[{"gross_charge":6795.0,"discounted_cash":4077.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMVL SUTURES UNDER ANES DIFF SURG","code_information":[{"code":"9750644","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15851","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX TALOTARSAL JNT DISLOC W/O ANES","code_information":[{"code":"9750645","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":707.0,"discounted_cash":424.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX TALOTARSAL JNT DISLOC WITH ANES","code_information":[{"code":"9750646","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28575","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.0,"discounted_cash":801.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKLT FIX TALOTARSL JNT DISL W MANIP","code_information":[{"code":"9750647","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28576","type":"HCPCS"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":894.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXCIS LESION TENDON SHEATH/CAPS LEG/ANKL","code_information":[{"code":"9750648","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27630","type":"HCPCS"}],"standard_charges":[{"gross_charge":2108.0,"discounted_cash":1264.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLT THICK AUTOGRFT 1ST 100SQ CM INF/CHD","code_information":[{"code":"9750649","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15120","type":"HCPCS"}],"standard_charges":[{"gross_charge":4117.0,"discounted_cash":2470.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SPLT THCK AUTOGRFT EA AD 100SQCM INF/CHD","code_information":[{"code":"9750650","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15121","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":687.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX ANT PELVIC FX/DISLC INC INTRNL FIX","code_information":[{"code":"9750651","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27217","type":"HCPCS"}],"standard_charges":[{"gross_charge":5550.0,"discounted_cash":3330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE, FOOT OR TOES","code_information":[{"code":"9750652","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28899","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.0,"discounted_cash":834.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX TALOTARSAL JT DISLOC W/INT FIX","code_information":[{"code":"9750653","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28585","type":"HCPCS"}],"standard_charges":[{"gross_charge":2892.0,"discounted_cash":1735.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX SCAPULAR FRACTURE W/O MANIP-RT","code_information":[{"code":"9750654","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":460.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX SCAPULAR FRACTURE W'1/O MANIP-LT","code_information":[{"code":"9750655","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23570","type":"HCPCS"}],"standard_charges":[{"gross_charge":768.0,"discounted_cash":460.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRODESIS, ANKLE, OPEN","code_information":[{"code":"9750656","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27870","type":"HCPCS"}],"standard_charges":[{"gross_charge":3417.0,"discounted_cash":2050.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26020 PRO DRAINAGE OF TENDON SHEATH DIGIT &/OR PALM EA","code_information":[{"code":"9750658","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26020","type":"HCPCS"}],"standard_charges":[{"gross_charge":1348.0,"discounted_cash":808.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DEBRIDE MUSCLE &/OR FASCIA EA ADD 20 SQ CM","code_information":[{"code":"9750662","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11046","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":184.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHRODESIS DECOMPRESS SPINAL CORD CERVICAL","code_information":[{"code":"9750668","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22551","type":"HCPCS"}],"standard_charges":[{"gross_charge":7171.0,"discounted_cash":4302.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22552 PRO ARTHRODESIS, DECOMP SPINAL CRD; CERV EA ADD","code_information":[{"code":"9750669","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.0,"discounted_cash":1093.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPAIR RUPT MUSCULOTENDINOUS CUFF ACUTE","code_information":[{"code":"9750671","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23410","type":"HCPCS"}],"standard_charges":[{"gross_charge":11922.0,"discounted_cash":7153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPAIR RUPT MUSCULOTENDINOUS CUFF CHRONIC","code_information":[{"code":"9750672","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23412","type":"HCPCS"}],"standard_charges":[{"gross_charge":11922.0,"discounted_cash":7153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX SCAPULAR FX INC INTERNAL FIXATION","code_information":[{"code":"9750673","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23585","type":"HCPCS"}],"standard_charges":[{"gross_charge":16851.0,"discounted_cash":10110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OSTEOTOMY FEMUR SHAFT OR SUPRACONDULAR - RT","code_information":[{"code":"9750674","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27448","type":"HCPCS"}],"standard_charges":[{"gross_charge":16851.0,"discounted_cash":10110.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OSTEOTOMY FEMUR SHAFT OR SUPRACONDULAR - LT","code_information":[{"code":"9750675","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27448","type":"HCPCS"}],"standard_charges":[{"gross_charge":16851.0,"discounted_cash":10110.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC UNLISTED PROCEDURE FEMUR OR KNEE","code_information":[{"code":"9750676","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27599","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.0,"discounted_cash":460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX METATARSOPHALANGEAL JNT DISLOCATION","code_information":[{"code":"9750677","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28645","type":"HCPCS"}],"standard_charges":[{"gross_charge":6690.0,"discounted_cash":4014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX ACETABULUM FRACTURE W MANIP - RT","code_information":[{"code":"9750678","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3558.0,"discounted_cash":2134.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX ACETABULUM FRACTURE W MANIP - LT","code_information":[{"code":"9750679","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27222","type":"HCPCS"}],"standard_charges":[{"gross_charge":3558.0,"discounted_cash":2134.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OSTEOPLASTY FEMUR; LENGTHENING - RT","code_information":[{"code":"9750680","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27466","type":"HCPCS"}],"standard_charges":[{"gross_charge":4312.0,"discounted_cash":2587.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OSTEOPLASTY FEMUR; LENGTHENING - LT","code_information":[{"code":"9750681","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27466","type":"HCPCS"}],"standard_charges":[{"gross_charge":4312.0,"discounted_cash":2587.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD CONDYLAR FEMORAL FX W/ MANIP-RT","code_information":[{"code":"9750682","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27503","type":"HCPCS"}],"standard_charges":[{"gross_charge":2914.0,"discounted_cash":1748.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD CONDYLAR FEMORAL FX W/ MANIP-LT","code_information":[{"code":"9750683","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27503","type":"HCPCS"}],"standard_charges":[{"gross_charge":2914.0,"discounted_cash":1748.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC FLUOROSCOPY UP TO 1 HOUR","code_information":[{"code":"9750684","type":"CDM"},{"code":"0975","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":314.0,"discounted_cash":188.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC STRESS VIEW(S) INCL CONTRALATERAL JNT","code_information":[{"code":"9750685","type":"CDM"},{"code":"0975","type":"RC"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":99.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMPRESSION FASCIOTOMY THIGH&/OR KNEE RT","code_information":[{"code":"9750686","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27498","type":"HCPCS"}],"standard_charges":[{"gross_charge":2263.0,"discounted_cash":1357.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMPRESSION FASCIOTOMY THIGH&/OR KNEE LT","code_information":[{"code":"9750687","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27498","type":"HCPCS"}],"standard_charges":[{"gross_charge":2263.0,"discounted_cash":1357.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MONITORING OF INTERSTITIAL FLUID PRESSURE RT","code_information":[{"code":"9750688","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MONITORING OF INTERSTITIAL FLUID PRESSURE LT","code_information":[{"code":"9750689","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":514.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TENOTOMY PERCUTANEOUS TOE; SINGLE TENDON","code_information":[{"code":"9750690","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28010","type":"HCPCS"}],"standard_charges":[{"gross_charge":756.0,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NEUROPLASTY MAJ PERIPH NERVE ARM OR LEG OPEN","code_information":[{"code":"9750691","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64708","type":"HCPCS"}],"standard_charges":[{"gross_charge":5785.0,"discounted_cash":3471.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC SKELETAL FIX CARPOMETACARPAL DISLOC EA JT","code_information":[{"code":"9750692","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26676","type":"HCPCS"}],"standard_charges":[{"gross_charge":6690.0,"discounted_cash":4014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC I&D DEEP ABSCESS/HEMATOMA PELVIS/HIP","code_information":[{"code":"9750693","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26990","type":"HCPCS"}],"standard_charges":[{"gross_charge":5789.0,"discounted_cash":3473.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LENGTHENING OF HAMSTRING TENDON; SINGLE","code_information":[{"code":"9750694","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27393","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LENGTHENING OF HAMSTRING TENDON; MULT 1 LEG","code_information":[{"code":"9750695","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27394","type":"HCPCS"}],"standard_charges":[{"gross_charge":8923.0,"discounted_cash":5353.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC LENGTHENING OF HAMSTRING TENDON; MULT BILAT","code_information":[{"code":"9750696","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27395","type":"HCPCS"}],"standard_charges":[{"gross_charge":11922.0,"discounted_cash":7153.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX FEM FX PROX/NECK INT FIX OR PROS-RT","code_information":[{"code":"9750697","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27236","type":"HCPCS"}],"standard_charges":[{"gross_charge":4372.0,"discounted_cash":2623.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX FEM FX PROX/NECK INT FIX OR PROS-LT","code_information":[{"code":"9750698","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27236","type":"HCPCS"}],"standard_charges":[{"gross_charge":4372.0,"discounted_cash":2623.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC QUADRICEPSPLASTY (BENNETT OR THOMPSON TYPE)-RT","code_information":[{"code":"9750699","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2471.0,"discounted_cash":1482.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC QUADRICEPSPLASTY (BENNETT OR THOMPSON TYPE)-LT","code_information":[{"code":"9750700","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2471.0,"discounted_cash":1482.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CAPSULOTOMY POST CAPSULAR RELEASE KNEE-RT","code_information":[{"code":"9750701","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":1609.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CAPSULOTOMY POST CAPSULAR RELEASE KNEE-LT","code_information":[{"code":"9750702","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27435","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":1609.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROPLASTY PATELLA WITHOUT PROSTHESIS-RT","code_information":[{"code":"9750703","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27437","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":1323.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROPLASTY PATELLA WITHOUT PROSTHESIS-LT","code_information":[{"code":"9750704","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27437","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":1323.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROPLASTY PATELLA WITH PROSTHESIS-RT","code_information":[{"code":"9750705","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27438","type":"HCPCS"}],"standard_charges":[{"gross_charge":2818.0,"discounted_cash":1690.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROPLASTY PATELLA WITH PROSTHESIS-LT","code_information":[{"code":"9750706","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27438","type":"HCPCS"}],"standard_charges":[{"gross_charge":2818.0,"discounted_cash":1690.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP PRIM DISRUPT LIGAMENT ANKLE;COLLAT-RT","code_information":[{"code":"9750707","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP PRIM DISRUPT LIGAMENT ANKLE;COLLAT-LT","code_information":[{"code":"9750708","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27695","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP PRIM DISRUPT LIGAMNT ANKLE BOTH COLLAT-RT","code_information":[{"code":"9750709","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27696","type":"HCPCS"}],"standard_charges":[{"gross_charge":8559.0,"discounted_cash":5135.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP PRIM DISRUPT LIGAMNT ANKLE BOTH COLLAT-LT","code_information":[{"code":"9750710","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27696","type":"HCPCS"}],"standard_charges":[{"gross_charge":8559.0,"discounted_cash":5135.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP SECNDRY DISRUPT LIGAMNT ANKLE COLLAT-RT","code_information":[{"code":"9750711","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27698","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP SECNDRY DISRUPT LIGAMNT ANKLE COLLAT-LT","code_information":[{"code":"9750712","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27698","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN & CLSD TX RAD SHAFT FX & RAD JT W/INT FIX","code_information":[{"code":"9750713","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25525","type":"HCPCS"}],"standard_charges":[{"gross_charge":12125.0,"discounted_cash":7275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX RAD SHAFT FX & RADIOULNAR JNT W/INT FIX","code_information":[{"code":"9750714","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25526","type":"HCPCS"}],"standard_charges":[{"gross_charge":12125.0,"discounted_cash":7275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP TENDON OR MUSCLE UPP ARM/ELBOW EACH-RT","code_information":[{"code":"9750715","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24341","type":"HCPCS"}],"standard_charges":[{"gross_charge":11922.0,"discounted_cash":7153.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP TENDON OR MUSCLE UPP ARM/ELBOW EACH-LT","code_information":[{"code":"9750716","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24341","type":"HCPCS"}],"standard_charges":[{"gross_charge":11922.0,"discounted_cash":7153.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REINSERT RUPT BICEP/TRICEP TENDON DISTAL-RT","code_information":[{"code":"9750717","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24342","type":"HCPCS"}],"standard_charges":[{"gross_charge":11922.0,"discounted_cash":7153.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REINSERT RUPT BICEP/TRICEP TENDON DISTAL-LT","code_information":[{"code":"9750718","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24342","type":"HCPCS"}],"standard_charges":[{"gross_charge":11922.0,"discounted_cash":7153.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP LAT COLLATERAL LIGMNT ELBOW W/ TISS-RT","code_information":[{"code":"9750719","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24343","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP LAT COLLATERAL LIGMNT ELBOW W/ TISS-LT","code_information":[{"code":"9750720","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24343","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC RECON LAT COLLAT LIGMNT ELBOW W/TEND GRFT-RT","code_information":[{"code":"9750721","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24344","type":"HCPCS"}],"standard_charges":[{"gross_charge":22414.0,"discounted_cash":13448.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC RECON LAT COLLAT LIGMNT ELBOW W/TEND GRFT-LT","code_information":[{"code":"9750722","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24344","type":"HCPCS"}],"standard_charges":[{"gross_charge":22414.0,"discounted_cash":13448.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP MEDIAL COLLAT LIGMNT ELBOW W/TISSUE-RT","code_information":[{"code":"9750723","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24345","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP MEDIAL COLLAT LIGMNT ELBOW W/TISSUE-LT","code_information":[{"code":"9750724","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24345","type":"HCPCS"}],"standard_charges":[{"gross_charge":8124.0,"discounted_cash":4874.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REM OF FB, UPPER ARM OR ELBOW; SUBCUTANEOUS","code_information":[{"code":"9750737","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1311.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REM OF FB, UPPER ARM OR ELBOW; DEEP","code_information":[{"code":"9750738","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24201","type":"HCPCS"}],"standard_charges":[{"gross_charge":4249.0,"discounted_cash":2549.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TX OF SUPERFICIAL WOUND DEHISC; SIMPLE CLOS","code_information":[{"code":"9750739","type":"CDM"},{"code":"0975","type":"RC"},{"code":"12020","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":463.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC UNLISTED PROCEDURE, LEG OR ANKLE","code_information":[{"code":"9750740","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27899","type":"HCPCS"}],"standard_charges":[{"gross_charge":6313.0,"discounted_cash":3787.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERCUTANEOUS SKELETAL FIXATION FEMUR FX","code_information":[{"code":"9750741","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27509","type":"HCPCS"}],"standard_charges":[{"gross_charge":5824.0,"discounted_cash":3494.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TX TARSAL BONE FX W MANIPULATION EA","code_information":[{"code":"9750742","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28455","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.0,"discounted_cash":491.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC SKELETAL FIX TARSAL BONE W MANIP EA","code_information":[{"code":"9750743","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28456","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":558.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRODESIS POST SINGLE SEGMENT; LUMBAR","code_information":[{"code":"9750744","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22633","type":"HCPCS"}],"standard_charges":[{"gross_charge":4596.0,"discounted_cash":2757.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHRODESIS POST EA ADDTL INTERSPACE","code_information":[{"code":"9750745","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1237.0,"discounted_cash":742.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXCISION; ISCHIAL BURSA","code_information":[{"code":"9750746","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27060","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":847.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC; TROCHANTERIC BURSA OR CALCIFICATION","code_information":[{"code":"9750747","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27062","type":"HCPCS"}],"standard_charges":[{"gross_charge":5461.0,"discounted_cash":3276.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP NONUNION FEMUR DIST TO HEAD; WO GRAFT-RT","code_information":[{"code":"9750748","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4067.0,"discounted_cash":2440.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP NONUNION FEMUR DISTAL TO HEAD; WO GRAFT-LT","code_information":[{"code":"9750749","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4067.0,"discounted_cash":2440.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLOSED TX PATELLAR FRACTURE W/O MANIP-RT","code_information":[{"code":"9750750","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":228.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLOSED TX PATELLAR FRACTURE W/O MANIP-LT","code_information":[{"code":"9750751","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27520","type":"HCPCS"}],"standard_charges":[{"gross_charge":381.0,"discounted_cash":228.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX POST & ANT ACETAB WALL FX W/FIX-RT","code_information":[{"code":"9750752","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":1559.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX POST & ANT ACETAB WALL FX W/FIX-LT","code_information":[{"code":"9750753","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":1559.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC UNLISTED PROCEDURE, PELVIS OR HIP JOINT","code_information":[{"code":"9750754","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27299","type":"HCPCS"}],"standard_charges":[{"gross_charge":2566.0,"discounted_cash":1539.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY KNEE; MEDIAL OR LATERAL-RT","code_information":[{"code":"9750755","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27332","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.0,"discounted_cash":1445.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE; MEDIAL OR LATERAL-LT","code_information":[{"code":"9750756","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27332","type":"HCPCS"}],"standard_charges":[{"gross_charge":2409.0,"discounted_cash":1445.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE; MEDIAL AND LATERAL-RT","code_information":[{"code":"9750757","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27333","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1318.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE; MEDIAL AND LATERAL-LT","code_information":[{"code":"9750758","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27333","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1318.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE W/SYNOVEC ANT OR POST-RT","code_information":[{"code":"9750759","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2579.0,"discounted_cash":1547.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE W/SYNOVEC ANT OR POST-LT","code_information":[{"code":"9750760","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27334","type":"HCPCS"}],"standard_charges":[{"gross_charge":2579.0,"discounted_cash":1547.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE W/SYNOVEC ANT AND POST-RT","code_information":[{"code":"9750761","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27335","type":"HCPCS"}],"standard_charges":[{"gross_charge":2895.0,"discounted_cash":1737.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY KNEE W/SYNOVEC ANT AND POST-LT","code_information":[{"code":"9750762","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27335","type":"HCPCS"}],"standard_charges":[{"gross_charge":2895.0,"discounted_cash":1737.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC UNLISTED PROCEDURE PELVIS OR HIP JOINT","code_information":[{"code":"9750763","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27299","type":"HCPCS"}],"standard_charges":[{"gross_charge":4545.0,"discounted_cash":2727.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY, ANKLE W/ OR W/O VX OR FB REMV-RT","code_information":[{"code":"9750764","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":858.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, ANKLE W/ OR W/O VX OR FB REMV-LT","code_information":[{"code":"9750765","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27620","type":"HCPCS"}],"standard_charges":[{"gross_charge":1431.0,"discounted_cash":858.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, WITH SYNOVECTOMY, ANKLE-RT","code_information":[{"code":"9750766","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, WITH SYNOVECTOMY, ANKLE-LT","code_information":[{"code":"9750767","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1809.0,"discounted_cash":1085.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, INCLUDING TENOSYNOVECTOMY-RT","code_information":[{"code":"9750768","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27626","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.0,"discounted_cash":1200.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, INCLUDING TENOSYNOVECTOMY-LT","code_information":[{"code":"9750769","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27626","type":"HCPCS"}],"standard_charges":[{"gross_charge":2001.0,"discounted_cash":1200.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR TORN LIGAMENT &/OR CAPSULE KNEE-RT","code_information":[{"code":"9750770","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR TORN LIGAMENT &/OR CAPSULE KNEE-LT","code_information":[{"code":"9750771","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2132.0,"discounted_cash":1279.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR TORN LIGAMENT &/OR CAPSL CRUTIATE-RT","code_information":[{"code":"9750772","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27407","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.0,"discounted_cash":1486.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR TORN LIGAMENT &/OR CAPSL CRUTIATE-LT","code_information":[{"code":"9750773","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27407","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.0,"discounted_cash":1486.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPR TORN LIG &/OR CAPSL COLL&CRUTIATE-RT","code_information":[{"code":"9750774","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3049.0,"discounted_cash":1829.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPR TORN LIG &/OR CAPSL COLL&CRUTIATE-LT","code_information":[{"code":"9750775","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3049.0,"discounted_cash":1829.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION THIGH THRU FEMUR ANY LEVEL-RT","code_information":[{"code":"9750776","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27590","type":"HCPCS"}],"standard_charges":[{"gross_charge":3479.0,"discounted_cash":2087.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION THIGH THRU FEMUR ANY LEVEL-LT","code_information":[{"code":"9750777","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27590","type":"HCPCS"}],"standard_charges":[{"gross_charge":3479.0,"discounted_cash":2087.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20240 PRO BIOPSY, BONE, OPEN, SUPERFICIAL","code_information":[{"code":"9750779","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20240","type":"HCPCS"}],"standard_charges":[{"gross_charge":5657.0,"discounted_cash":3394.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20245 PRO BIOPSY,BONE,OPEN, DEEP","code_information":[{"code":"9750780","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20245","type":"HCPCS"}],"standard_charges":[{"gross_charge":6175.0,"discounted_cash":3705.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLOSED HUMERAL SHAFT FX W/MANIP-RT","code_information":[{"code":"9750781","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.0,"discounted_cash":1427.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLOSED HUMERAL SHAFT FX W/MANIP-LT","code_information":[{"code":"9750782","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.0,"discounted_cash":1427.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/MENISCECTOMY MED&LAT-RT","code_information":[{"code":"9750783","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1269.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/ MENISCECTOMY MED&LAT-LT","code_information":[{"code":"9750784","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2115.0,"discounted_cash":1269.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/MENISCECTOMY MED OR LAT-RT","code_information":[{"code":"9750785","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29881","type":"HCPCS"}],"standard_charges":[{"gross_charge":2028.0,"discounted_cash":1216.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/MENISCECTOMY MED OR LAT-LT","code_information":[{"code":"9750786","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29881","type":"HCPCS"}],"standard_charges":[{"gross_charge":2028.0,"discounted_cash":1216.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/MENISCUS REPR MED OR LAT-RT","code_information":[{"code":"9750787","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29882","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1555.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/MENISCUS REPR MED OR LAT-LT","code_information":[{"code":"9750788","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29882","type":"HCPCS"}],"standard_charges":[{"gross_charge":2592.0,"discounted_cash":1555.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/MENISCUS REPR MED&LAT-RT","code_information":[{"code":"9750789","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29883","type":"HCPCS"}],"standard_charges":[{"gross_charge":3387.0,"discounted_cash":2032.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHRO KNEE SURG W/MENISCUS REPR MED&LAT-LT","code_information":[{"code":"9750790","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29883","type":"HCPCS"}],"standard_charges":[{"gross_charge":3387.0,"discounted_cash":2032.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC FULL THICK GRAFT INC CLOS DNR SITE 20SQCM<","code_information":[{"code":"9750791","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15240","type":"HCPCS"}],"standard_charges":[{"gross_charge":2746.0,"discounted_cash":1647.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC/CURETTAGE BONE CYST OR TUMOR;TIB/FIB","code_information":[{"code":"9750792","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27635","type":"HCPCS"}],"standard_charges":[{"gross_charge":2239.0,"discounted_cash":1343.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC/CURETT BONE CYST/TUMOR;TIB/FIB W/AUTOGRAFT","code_information":[{"code":"9750793","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27637","type":"HCPCS"}],"standard_charges":[{"gross_charge":2874.0,"discounted_cash":1724.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC/CURETT BONE CYST/TUMOR;TIB/FIB W/ALLOGRAFT","code_information":[{"code":"9750794","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27638","type":"HCPCS"}],"standard_charges":[{"gross_charge":2941.0,"discounted_cash":1764.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PARTIAL EXCISION, BONE; TIBIA","code_information":[{"code":"9750795","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27640","type":"HCPCS"}],"standard_charges":[{"gross_charge":3462.0,"discounted_cash":2077.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PARTIAL EXCISION OF BONE; ULNA","code_information":[{"code":"9750796","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25150","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.0,"discounted_cash":1282.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PARTIAL EXCISION OF BONE; RADIUS","code_information":[{"code":"9750797","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25151","type":"HCPCS"}],"standard_charges":[{"gross_charge":2258.0,"discounted_cash":1354.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX RADIO/INTERCARPAL DISLOC W/MAN-RT","code_information":[{"code":"9750798","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX RADIO/INTERCARPAL DISLOC W/MAN-LT","code_information":[{"code":"9750799","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D FOREARM/WRIST DEEP ABCESS/HEMATOMA-RT","code_information":[{"code":"9750800","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":1936.0,"discounted_cash":1161.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D FOREARM/WRIST DEEP ABCESS/HEMATOMA-LT","code_information":[{"code":"9750801","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25028","type":"HCPCS"}],"standard_charges":[{"gross_charge":1936.0,"discounted_cash":1161.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D FOREARM/WRIST BURSA-RT","code_information":[{"code":"9750802","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":823.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D FOREARM/WRIST BURSA-LT","code_information":[{"code":"9750803","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25031","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":823.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INCISION DEEP BONE CORTEX FOREARM/WRIST-RT","code_information":[{"code":"9750804","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2256.0,"discounted_cash":1353.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INCISION DEEP BONE CORTEX FOREARM/WRIST-LT","code_information":[{"code":"9750805","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2256.0,"discounted_cash":1353.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D UPPER ARM/ELBOW AREA DEEP ABSCESS-RT","code_information":[{"code":"9750806","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":492.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D UPPER ARM/ELBOW AREA DEEP ABSCESS-LT","code_information":[{"code":"9750807","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23930","type":"HCPCS"}],"standard_charges":[{"gross_charge":820.0,"discounted_cash":492.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D UPPER ARM OR ELBOW AREA BURSA-RT","code_information":[{"code":"9750808","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":357.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC I&D UPPER ARM OR ELBOW AREA BURSA-LT","code_information":[{"code":"9750809","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":357.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC EXCISION OLECRANON BURSA-RT","code_information":[{"code":"9750810","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":774.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC EXCISION OLECRANON BURSA-LT","code_information":[{"code":"9750811","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.0,"discounted_cash":774.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION FOREARM THROUGH RADIUS/ULNA-RT","code_information":[{"code":"9750812","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2951.0,"discounted_cash":1770.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION FOREARM THROUGH RADIUS/ULNA-LT","code_information":[{"code":"9750813","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25900","type":"HCPCS"}],"standard_charges":[{"gross_charge":2951.0,"discounted_cash":1770.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION FOREARM, OPEN, CIRCULAR-RT","code_information":[{"code":"9750814","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25905","type":"HCPCS"}],"standard_charges":[{"gross_charge":2908.0,"discounted_cash":1744.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION FOREARM, OPEN, CIRCULAR-LT","code_information":[{"code":"9750815","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25905","type":"HCPCS"}],"standard_charges":[{"gross_charge":2908.0,"discounted_cash":1744.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 11011 PRO DEBRIDE W/ FB REMOVE SKIN/SQ/MUSCLE","code_information":[{"code":"9750816","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2145.0,"discounted_cash":1287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SURGICAL PREP < 100 SQ CM","code_information":[{"code":"9750817","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC HARVEST SKIN FOR AUTOGRAFT 100 SQ CM OR <","code_information":[{"code":"9750818","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC TUMOR SOFT TISS FOOT/TOE SUBFASCL<1.5CM","code_information":[{"code":"9750819","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28045","type":"HCPCS"}],"standard_charges":[{"gross_charge":1839.0,"discounted_cash":1103.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX METACARPOPHALAN DISLC SGL W/MANIP/ANES","code_information":[{"code":"9750820","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":984.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NERVE REPAIR W/ ALLOGRAFT EACH NERVE","code_information":[{"code":"9750821","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64910","type":"HCPCS"}],"standard_charges":[{"gross_charge":3132.0,"discounted_cash":1879.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC NERVE REPAIR W/ VEIN AUTOGRAFT EA NERVE","code_information":[{"code":"9750822","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64911","type":"HCPCS"}],"standard_charges":[{"gross_charge":3934.0,"discounted_cash":2360.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX ELBOW DISLOC W/O ANES-RT","code_information":[{"code":"9750823","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2403.0,"discounted_cash":1441.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX ELBOW DISLOC W/O ANES-LT","code_information":[{"code":"9750824","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":2403.0,"discounted_cash":1441.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX ELBOW DISLOC W/ ANES-RT","code_information":[{"code":"9750825","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3444.0,"discounted_cash":2066.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX ELBOW DISLOC W/ ANES-LT","code_information":[{"code":"9750826","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3444.0,"discounted_cash":2066.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX DIST PHAL FX FINGER/THUMB EA","code_information":[{"code":"9750827","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26765","type":"HCPCS"}],"standard_charges":[{"gross_charge":6307.0,"discounted_cash":3784.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX OF INTERTROCHANTERIC FX W MANIP-RT","code_information":[{"code":"9750828","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":976.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX OF INTERTROCHANTERIC FX W MANIP-LT","code_information":[{"code":"9750829","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":976.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD MEDIAL MALLEOLOUS FX W/MAN-RT","code_information":[{"code":"9750830","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":830.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD MEDIAL MALLEOLOUS FX W/MAN-LT","code_information":[{"code":"9750831","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1384.0,"discounted_cash":830.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY CARPOMETACARPAL JOINT","code_information":[{"code":"9750832","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1094.0,"discounted_cash":656.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY INTERPHALANGEAL JOINT EACH","code_information":[{"code":"9750833","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26080","type":"HCPCS"}],"standard_charges":[{"gross_charge":1358.0,"discounted_cash":814.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REP TENDON/MUS FOREARM SGL PRIM EA TEND/MUS-RT","code_information":[{"code":"9750834","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1796.0,"discounted_cash":1077.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP TENDON/MUS FOREARM SGL PRIM EA TEND/MUS-LT","code_information":[{"code":"9750835","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1796.0,"discounted_cash":1077.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP TENDON/MUS FOREARM SGL 2NDARY EA TEND/MUS","code_information":[{"code":"9750836","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25272","type":"HCPCS"}],"standard_charges":[{"gross_charge":2020.0,"discounted_cash":1212.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMP FASCIOTOMY THIGH &/OR KNEE 1 COMP-RT","code_information":[{"code":"9750837","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27496","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.0,"discounted_cash":1135.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOMP FASCIOTOMY THIGH &/OR KNEE 1 COMP-LT","code_information":[{"code":"9750838","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27496","type":"HCPCS"}],"standard_charges":[{"gross_charge":1893.0,"discounted_cash":1135.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC MUSCLE, MYOCUTANEOUS FLAP, TRUNK","code_information":[{"code":"9750839","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15734","type":"HCPCS"}],"standard_charges":[{"gross_charge":5268.0,"discounted_cash":3160.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC MUSCLE, MYOCUTANEOUS FLAP UPP EXTREM-RT","code_information":[{"code":"9750840","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15736","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":2733.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC MUSCLE, MYOCUTANEOUS FLAP UPP EXTREM-LT","code_information":[{"code":"9750841","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15736","type":"HCPCS"}],"standard_charges":[{"gross_charge":4555.0,"discounted_cash":2733.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC MUSCLE, MYOCUTANEOUS FLAP LOW EXTREM-RT","code_information":[{"code":"9750842","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15738","type":"HCPCS"}],"standard_charges":[{"gross_charge":4946.0,"discounted_cash":2967.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC MUSCLE, MYOCUTANEOUS FLAP LOW EXTREM-LT","code_information":[{"code":"9750843","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15738","type":"HCPCS"}],"standard_charges":[{"gross_charge":4946.0,"discounted_cash":2967.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ELECTRICAL BONE STIMULATION","code_information":[{"code":"9750846","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20975","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.0,"discounted_cash":414.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECORTICATION, PULMONARY; TOTAL","code_information":[{"code":"9750847","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32220","type":"HCPCS"}],"standard_charges":[{"gross_charge":5366.0,"discounted_cash":3219.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC DECORTICATION, PULMONARY; PARTIAL","code_information":[{"code":"9750848","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32225","type":"HCPCS"}],"standard_charges":[{"gross_charge":3358.0,"discounted_cash":2014.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC PARTIAL REMOVAL OF LUNG, SINGLE LOBE","code_information":[{"code":"9750849","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32480","type":"HCPCS"}],"standard_charges":[{"gross_charge":3628.0,"discounted_cash":2176.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC PARTIAL REMOVAL OF LUNG, 2 LOBES","code_information":[{"code":"9750850","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32482","type":"HCPCS"}],"standard_charges":[{"gross_charge":3879.0,"discounted_cash":2327.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REMOVAL OF LUNG, OTHER THAN PNEUMO;SGL SEGMENT","code_information":[{"code":"9750851","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32484","type":"HCPCS"}],"standard_charges":[{"gross_charge":4859.0,"discounted_cash":2915.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REMOVAL OF LUNG-SLEEVE LOBECTOMY","code_information":[{"code":"9750852","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32486","type":"HCPCS"}],"standard_charges":[{"gross_charge":5771.0,"discounted_cash":3462.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOTOMY;W/THER WEDGE RESECTION, INITIAL","code_information":[{"code":"9750853","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32505","type":"HCPCS"}],"standard_charges":[{"gross_charge":3220.0,"discounted_cash":1932.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOTOMY;W/THER WEDGE RESECTION, EA ADD SEG","code_information":[{"code":"9750854","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32506","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.0,"discounted_cash":337.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC INS TUNNELED PLEURAL CATHETER W/ CUFF","code_information":[{"code":"9750855","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":1709.0,"discounted_cash":1025.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC INSERTION OF CHEST TUBE","code_information":[{"code":"9750856","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":239.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVE INDWELLING TUNNELED PLEURAL CATH WITH CUFF","code_information":[{"code":"9750857","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THORACENTESIS, NEEDLE OR CATHETER W/O IMAGING","code_information":[{"code":"9750858","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THORACENTESIS, NEEDLE OR CATHETER W/ IMAGING","code_information":[{"code":"9750859","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":348.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC THORACOSCOPY, SURGICAL; WITH PLEURODESIS","code_information":[{"code":"9750860","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2196.0,"discounted_cash":1317.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOSCOPY, SURGICAL; WITH PARTIAL PULM DECORT","code_information":[{"code":"9750861","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32651","type":"HCPCS"}],"standard_charges":[{"gross_charge":3615.0,"discounted_cash":2169.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOSCOPY, SURGICAL; W/TOTAL PULM DECORT","code_information":[{"code":"9750862","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32652","type":"HCPCS"}],"standard_charges":[{"gross_charge":5490.0,"discounted_cash":3294.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOSCOPY, SURGICAL;W/REMOVAL OF FB","code_information":[{"code":"9750863","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32653","type":"HCPCS"}],"standard_charges":[{"gross_charge":3485.0,"discounted_cash":2091.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOSCOPY,SURGICAL; W/CONTROL HEMORRHAGE","code_information":[{"code":"9750864","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32654","type":"HCPCS"}],"standard_charges":[{"gross_charge":3892.0,"discounted_cash":2335.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOSCOPY W/SAC FB REMOVAL","code_information":[{"code":"9750865","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32658","type":"HCPCS"}],"standard_charges":[{"gross_charge":1707.0,"discounted_cash":1024.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOSCOPY W/PERICARDIAL WINDOW FOR DRAINAGE","code_information":[{"code":"9750866","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32659","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":1044.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC UNLISTED PROCEDURE; LUNGS AND PLEURA","code_information":[{"code":"9750867","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32999","type":"HCPCS"}],"standard_charges":[{"gross_charge":2545.0,"discounted_cash":1527.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC PERICARDIOTOMY FOR REMOVAL OF CLOT OR FB","code_information":[{"code":"9750869","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33020","type":"HCPCS"}],"standard_charges":[{"gross_charge":2048.0,"discounted_cash":1228.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC PERICARDIAL WINDOW OR PARTIAL RESECT FOR DRAIN","code_information":[{"code":"9750870","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1874.0,"discounted_cash":1124.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TRANSMYOCARDIAL LASER REVASCULARIZATION","code_information":[{"code":"9750871","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3735.0,"discounted_cash":2241.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TRANSMYO LASER REVAS, BY THORA;PERF W/OTHER PRO","code_information":[{"code":"9750872","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33141","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.0,"discounted_cash":260.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC INSERT EPICARDIAL ELECTRODE(S); OPEN INCISION","code_information":[{"code":"9750873","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33202","type":"HCPCS"}],"standard_charges":[{"gross_charge":2628.0,"discounted_cash":1576.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REMOVE PACING CARDIO-DEFIB PULSE GENERATOR ONLY","code_information":[{"code":"9750874","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":3694.0,"discounted_cash":2216.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REM SGL OR DUAL ICD ELECTRODE(S);BY THORACOTOMY","code_information":[{"code":"9750875","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33243","type":"HCPCS"}],"standard_charges":[{"gross_charge":4411.0,"discounted_cash":2646.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REM SGL OR DUAL CARDIO-DEFIB ELECT BY TRANS EXTR","code_information":[{"code":"9750876","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33244","type":"HCPCS"}],"standard_charges":[{"gross_charge":3694.0,"discounted_cash":2216.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATE HEART DYSRHYTHM FOCUS W/O BYPASS","code_information":[{"code":"9750877","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33250","type":"HCPCS"}],"standard_charges":[{"gross_charge":3479.0,"discounted_cash":2087.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATE HEART DYSRHYTHM FOCUS W/ BYPASS","code_information":[{"code":"9750878","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33251","type":"HCPCS"}],"standard_charges":[{"gross_charge":3832.0,"discounted_cash":2299.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATION & RECONSTRUCTION OF ATRIA, LIMITED","code_information":[{"code":"9750879","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33254","type":"HCPCS"}],"standard_charges":[{"gross_charge":3231.0,"discounted_cash":1938.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATION & RECONSTRUCT OF ATRIA, EXTENS W/O BYPASS","code_information":[{"code":"9750880","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33255","type":"HCPCS"}],"standard_charges":[{"gross_charge":3888.0,"discounted_cash":2332.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATION & RECONSTRUCT OF ATRIA, EXTENS W/ BYPASS","code_information":[{"code":"9750881","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33256","type":"HCPCS"}],"standard_charges":[{"gross_charge":4621.0,"discounted_cash":2772.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATE & RECONS ATRIA, WITH CARDIAC PROC, LIMIT","code_information":[{"code":"9750882","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33257","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.0,"discounted_cash":823.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATE & RECONS ATRIA, WITH CARDIAC PROC, EXTENS","code_information":[{"code":"9750883","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33258","type":"HCPCS"}],"standard_charges":[{"gross_charge":1545.0,"discounted_cash":927.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATE & RECON ATRIA, W/ CARD PRO, EXTEN, W/ BYPAS","code_information":[{"code":"9750884","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33259","type":"HCPCS"}],"standard_charges":[{"gross_charge":1995.0,"discounted_cash":1197.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ABLATION OF VENTRICULAR FOCUS W/ BYPASS","code_information":[{"code":"9750885","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33261","type":"HCPCS"}],"standard_charges":[{"gross_charge":3854.0,"discounted_cash":2312.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC INSERTION OF A GRAFT W/O SHUNT OR BYPASS","code_information":[{"code":"9750886","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33330","type":"HCPCS"}],"standard_charges":[{"gross_charge":3579.0,"discounted_cash":2147.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC INSERT GRAFT, AORTA/GRT VESSELS W/ CARDIO BYPASS","code_information":[{"code":"9750888","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33335","type":"HCPCS"}],"standard_charges":[{"gross_charge":4440.0,"discounted_cash":2664.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/ PROSTH VALVE; PERC FEMORAL ART APPROACH","code_information":[{"code":"9750889","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33361","type":"HCPCS"}],"standard_charges":[{"gross_charge":4520.0,"discounted_cash":2712.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/PROSTH VALVE; OPEN FEMORAL ART APPROACH","code_information":[{"code":"9750890","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33362","type":"HCPCS"}],"standard_charges":[{"gross_charge":4720.0,"discounted_cash":2832.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/PROSTH VALVE; OPEN AXILLARY ART APPROACH","code_information":[{"code":"9750891","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33363","type":"HCPCS"}],"standard_charges":[{"gross_charge":4891.0,"discounted_cash":2934.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/PROSTH VALVE; OPEN ILIAC ART APPROACH","code_information":[{"code":"9750892","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33364","type":"HCPCS"}],"standard_charges":[{"gross_charge":5194.0,"discounted_cash":3116.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/PROSTH VALVE; TRANSAORTIC APPROACH","code_information":[{"code":"9750893","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33365","type":"HCPCS"}],"standard_charges":[{"gross_charge":5726.0,"discounted_cash":3435.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/PROSTH VALVE; W/BYPASS, PERCUT CANNULATION","code_information":[{"code":"9750894","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33367","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.0,"discounted_cash":1210.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/ PROSTH VALVE; W/BYPASS W/OPEN CANNULATION","code_information":[{"code":"9750895","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33368","type":"HCPCS"}],"standard_charges":[{"gross_charge":2444.0,"discounted_cash":1466.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TAVR W/PROSTH VALVE; W/BYPASS W/CENTRAL CANNULAT","code_information":[{"code":"9750896","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33369","type":"HCPCS"}],"standard_charges":[{"gross_charge":3225.0,"discounted_cash":1935.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC 33405 PRO REPAIR AORTIC VALVE,OPEN,W/BYPASS;PROSTHETIC VALVE","code_information":[{"code":"9750899","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33405","type":"HCPCS"}],"standard_charges":[{"gross_charge":5345.0,"discounted_cash":3207.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC 33406 PRO REPAIR AORTIC VALVE,OPEN,W/BYPASS;ALLOGRAFT VALVE","code_information":[{"code":"9750900","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33406","type":"HCPCS"}],"standard_charges":[{"gross_charge":6810.0,"discounted_cash":4086.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC 33410 PRO REPAIR AORTIC VALVE,OPEN,W/BYPASS;STENTLESS VALVE","code_information":[{"code":"9750901","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33410","type":"HCPCS"}],"standard_charges":[{"gross_charge":6006.0,"discounted_cash":3603.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REP AORTIC VALVE W/ AORTIC ENLARGE, NONCORO SINUS","code_information":[{"code":"9750902","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33411","type":"HCPCS"}],"standard_charges":[{"gross_charge":7943.0,"discounted_cash":4765.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REP AORTIC VALVE W/ TRANSVENT AORTIC ANNUL ENLARG","code_information":[{"code":"9750903","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33412","type":"HCPCS"}],"standard_charges":[{"gross_charge":7561.0,"discounted_cash":4536.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REP AORTIC VALVE; TRANSLOC PULM VALVE W/ REP VALVE","code_information":[{"code":"9750904","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33413","type":"HCPCS"}],"standard_charges":[{"gross_charge":7630.0,"discounted_cash":4578.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVOTOMY, MITRAL VALVE; CLOSED HEART","code_information":[{"code":"9750905","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33420","type":"HCPCS"}],"standard_charges":[{"gross_charge":4547.0,"discounted_cash":2728.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVOTOMY, MITRAL VALVE W/ BYPASS","code_information":[{"code":"9750906","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33422","type":"HCPCS"}],"standard_charges":[{"gross_charge":3984.0,"discounted_cash":2390.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVULOPLASTY, MITRAL VALVE W/ BYPASS","code_information":[{"code":"9750907","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33425","type":"HCPCS"}],"standard_charges":[{"gross_charge":6471.0,"discounted_cash":3882.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVULOPLASTY, MITRAL VALVE W/ BYPASS & PROS RING","code_information":[{"code":"9750908","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33426","type":"HCPCS"}],"standard_charges":[{"gross_charge":5638.0,"discounted_cash":3382.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVULOPLASTY MITRAL VALVE W/ BYPAS W/ OR W/O RNG","code_information":[{"code":"9750909","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33427","type":"HCPCS"}],"standard_charges":[{"gross_charge":5782.0,"discounted_cash":3469.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REPLACE, MITRAL VALVE, W/BYPASS","code_information":[{"code":"9750910","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33430","type":"HCPCS"}],"standard_charges":[{"gross_charge":9107.0,"discounted_cash":5464.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVECTOMY, TRICUSPID VALVE, W/BYPASS","code_information":[{"code":"9750911","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33460","type":"HCPCS"}],"standard_charges":[{"gross_charge":7957.0,"discounted_cash":4774.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVULOPLASTY, TRISCUPID VALVE; W/O RING INSERTION","code_information":[{"code":"9750912","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33463","type":"HCPCS"}],"standard_charges":[{"gross_charge":10094.0,"discounted_cash":6056.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC VALVULOPLASTY TRICUSPID VALVE; W/RING INSERTION","code_information":[{"code":"9750913","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33464","type":"HCPCS"}],"standard_charges":[{"gross_charge":7991.0,"discounted_cash":4794.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REPLACE TRICUSPID VALVE, W/BYPASS","code_information":[{"code":"9750914","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33465","type":"HCPCS"}],"standard_charges":[{"gross_charge":9019.0,"discounted_cash":5411.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ENDOSCOPY, HARVEST OF VEIN(S) FOR CABG PROCEDURE","code_information":[{"code":"9750915","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33508","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; VEIN ONLY, SINGLE VENOUS GRAFT","code_information":[{"code":"9750916","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33510","type":"HCPCS"}],"standard_charges":[{"gross_charge":4574.0,"discounted_cash":2744.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; VEIN ONLY, DOUBLE VENOUS GRAFT","code_information":[{"code":"9750917","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33511","type":"HCPCS"}],"standard_charges":[{"gross_charge":5024.0,"discounted_cash":3014.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; VEIN ONLY, TRIPLE VENOUS GRAFT","code_information":[{"code":"9750918","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33512","type":"HCPCS"}],"standard_charges":[{"gross_charge":5712.0,"discounted_cash":3427.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; VEIN ONLY, QUAD VENOUS GRAFT","code_information":[{"code":"9750919","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33513","type":"HCPCS"}],"standard_charges":[{"gross_charge":5878.0,"discounted_cash":3526.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS, VEIN ONLY, 5 VENOUS GRAFTS","code_information":[{"code":"9750920","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33514","type":"HCPCS"}],"standard_charges":[{"gross_charge":8563.0,"discounted_cash":5137.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS, VEIN ONLY, 6 OR MORE GRAFTS","code_information":[{"code":"9750921","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33516","type":"HCPCS"}],"standard_charges":[{"gross_charge":8943.0,"discounted_cash":5365.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORO BYPASS; USE VENOUS & ART GRAFTS; SGL VEIN GFT","code_information":[{"code":"9750922","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33517","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":369.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORO BYPASS; USE VENOUS & ART GRAFTS; 2 VEIN GFTS","code_information":[{"code":"9750923","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33518","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":810.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORO BYPASS; USE VENOUS & ART GRAFTS; 3 VEIN GFTS","code_information":[{"code":"9750924","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1786.0,"discounted_cash":1071.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORO BYPASS; USE VENOUS & ART GRAFTS;4 VEIN GFTS","code_information":[{"code":"9750925","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33521","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1287.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORO BYPASS;USE VENOUS & ART GRAFTS;5 VEIN GFTS","code_information":[{"code":"9750926","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33522","type":"HCPCS"}],"standard_charges":[{"gross_charge":2410.0,"discounted_cash":1446.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORO BYPASS; USE VENOUS & ART GRAFTS; 6 OR MORE","code_information":[{"code":"9750927","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33523","type":"HCPCS"}],"standard_charges":[{"gross_charge":2737.0,"discounted_cash":1642.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; SINGLE ARTERIAL GRAFT","code_information":[{"code":"9750928","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33533","type":"HCPCS"}],"standard_charges":[{"gross_charge":4399.0,"discounted_cash":2639.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; DOUBLE ARTERIAL GRAFT","code_information":[{"code":"9750929","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33534","type":"HCPCS"}],"standard_charges":[{"gross_charge":5200.0,"discounted_cash":3120.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; TRIPLE ARTERIAL GRAFT","code_information":[{"code":"9750930","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33535","type":"HCPCS"}],"standard_charges":[{"gross_charge":5797.0,"discounted_cash":3478.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC CORONARY BYPASS; QUADRUPLE ARTERIAL GRAFT","code_information":[{"code":"9750931","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33536","type":"HCPCS"}],"standard_charges":[{"gross_charge":6216.0,"discounted_cash":3729.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REMOVE AORTA CONSTRICTION W/ ANASTOMOSIS","code_information":[{"code":"9750932","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2936.0,"discounted_cash":1761.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REMOVE AORTA CONSTRICTION W/ GRAFT","code_information":[{"code":"9750933","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33845","type":"HCPCS"}],"standard_charges":[{"gross_charge":3158.0,"discounted_cash":1894.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REMOVE AORTA CONSTRICTION USING ARTERY OR PROST","code_information":[{"code":"9750934","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33851","type":"HCPCS"}],"standard_charges":[{"gross_charge":3015.0,"discounted_cash":1809.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REPAIR SEPTAL DEFECT W/O BYPASS","code_information":[{"code":"9750935","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33852","type":"HCPCS"}],"standard_charges":[{"gross_charge":3313.0,"discounted_cash":1987.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REPAIR SEPTAL DEFECT WITH BYPASS","code_information":[{"code":"9750936","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33853","type":"HCPCS"}],"standard_charges":[{"gross_charge":4346.0,"discounted_cash":2607.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ASCEND AORTIC GRAFT W/ BYPASS W/ AORTIC ROOT REP","code_information":[{"code":"9750938","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33863","type":"HCPCS"}],"standard_charges":[{"gross_charge":7448.0,"discounted_cash":4468.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ASCEND AORTIC GRAFT W/ BYPASS W/ VALVE SUSPENSION","code_information":[{"code":"9750939","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33864","type":"HCPCS"}],"standard_charges":[{"gross_charge":7605.0,"discounted_cash":4563.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACIC AORTIC GRAFT WITH OR WITHOUT BYPASS","code_information":[{"code":"9750940","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33875","type":"HCPCS"}],"standard_charges":[{"gross_charge":6497.0,"discounted_cash":3898.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOABDOMINAL GRAFT WITH OR WITHOUT BYPASS","code_information":[{"code":"9750941","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33877","type":"HCPCS"}],"standard_charges":[{"gross_charge":8646.0,"discounted_cash":5187.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ENDOVASCULAR REPAIR THORACIC AORTA ANEURYSM","code_information":[{"code":"9750942","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33880","type":"HCPCS"}],"standard_charges":[{"gross_charge":4496.0,"discounted_cash":2697.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ENDOVASCULAR REPAIR TAA W/O SUBCLAVIAN ORIGIN","code_information":[{"code":"9750943","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33881","type":"HCPCS"}],"standard_charges":[{"gross_charge":3858.0,"discounted_cash":2314.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC INSERT ENDOVASCULAR PROSTHETIC TAA, INITIAL","code_information":[{"code":"9750944","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33883","type":"HCPCS"}],"standard_charges":[{"gross_charge":2790.0,"discounted_cash":1674.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC PLACEMENT DISTAL EXT PROSTHESIS DELAYED","code_information":[{"code":"9750946","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33886","type":"HCPCS"}],"standard_charges":[{"gross_charge":2438.0,"discounted_cash":1462.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REM INTRA-AORIC BALLOON INC REPAIR OF FEM ARTERY","code_information":[{"code":"9750947","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33971","type":"HCPCS"}],"standard_charges":[{"gross_charge":2303.0,"discounted_cash":1381.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC ENDO PLACEMENT OF ILIAC ARTERY OCCLUSION DEVICE","code_information":[{"code":"9750954","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34808","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN FEM ART FOR DELIVERY ENDOVASCULAR PROSTHESIS","code_information":[{"code":"9750955","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34812","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":486.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC PLACE FEMORAL PROSTH GRAFT DURING AAA REPAIR","code_information":[{"code":"9750956","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34813","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN ILIAC ART FOR DELIVERY ENDOVASCULAR PROSTH","code_information":[{"code":"9750957","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34820","type":"HCPCS"}],"standard_charges":[{"gross_charge":1172.0,"discounted_cash":703.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN REPAIR INFRARENAL ANEURYSM W/TUBE PROSTH","code_information":[{"code":"9750960","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34830","type":"HCPCS"}],"standard_charges":[{"gross_charge":5921.0,"discounted_cash":3552.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN REP INFRARENAL ANEURYSM W/AORTO-BI-IL PROSTH","code_information":[{"code":"9750961","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34831","type":"HCPCS"}],"standard_charges":[{"gross_charge":6368.0,"discounted_cash":3820.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN REP INFRARENAL ANEURYSM W/AORTO-BIFEM PROSTH","code_information":[{"code":"9750962","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34832","type":"HCPCS"}],"standard_charges":[{"gross_charge":6368.0,"discounted_cash":3820.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN ILIAC ART FOR DELIV AORTIC/ILIAC PROSTHESIS","code_information":[{"code":"9750963","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34833","type":"HCPCS"}],"standard_charges":[{"gross_charge":1535.0,"discounted_cash":921.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN BRACHIAL ART TO ASSIST WITH PROSTH BY ARM INC","code_information":[{"code":"9750964","type":"CDM"},{"code":"0975","type":"RC"},{"code":"34834","type":"HCPCS"}],"standard_charges":[{"gross_charge":692.0,"discounted_cash":415.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REP BLOOD VESSEL W/ VEIN GFT; INTRATHOR W/ BYPASS","code_information":[{"code":"9750966","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35241","type":"HCPCS"}],"standard_charges":[{"gross_charge":3415.0,"discounted_cash":2049.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REP BLOOD VESS W/ VEIN GFT; INTRATHOR W/O BYPASS","code_information":[{"code":"9750967","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35246","type":"HCPCS"}],"standard_charges":[{"gross_charge":3471.0,"discounted_cash":2082.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REP BLOOD VESS W/GFT OTH THAN VEIN; INTRATH W/BYP","code_information":[{"code":"9750968","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35271","type":"HCPCS"}],"standard_charges":[{"gross_charge":3291.0,"discounted_cash":1974.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REP BLOOD VESS W/GFT OTH THAN VEIN; INTRATH W/O BYP","code_information":[{"code":"9750969","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35276","type":"HCPCS"}],"standard_charges":[{"gross_charge":3436.0,"discounted_cash":2061.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THROMBOENDARTERECTOMY INC PATCH GFT; NECK INC","code_information":[{"code":"9750970","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35301","type":"HCPCS"}],"standard_charges":[{"gross_charge":2529.0,"discounted_cash":1517.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REOPERATION, CAROTID, THROMBOENDARTERECTOMY","code_information":[{"code":"9750971","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35390","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; SUBCLAVIAN-AXILLARY","code_information":[{"code":"9750972","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35516","type":"HCPCS"}],"standard_charges":[{"gross_charge":2967.0,"discounted_cash":1780.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; AXILLARY-AXILLARY","code_information":[{"code":"9750973","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35518","type":"HCPCS"}],"standard_charges":[{"gross_charge":3110.0,"discounted_cash":1866.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL","code_information":[{"code":"9750974","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35521","type":"HCPCS"}],"standard_charges":[{"gross_charge":3353.0,"discounted_cash":2011.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; AXILLARY-BRACHIAL","code_information":[{"code":"9750975","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35522","type":"HCPCS"}],"standard_charges":[{"gross_charge":3136.0,"discounted_cash":1881.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; BRACHIAL-ULNAR OR-RADIAL","code_information":[{"code":"9750976","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35523","type":"HCPCS"}],"standard_charges":[{"gross_charge":3074.0,"discounted_cash":1844.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; BRACHIAL-BRACHIAL","code_information":[{"code":"9750977","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35525","type":"HCPCS"}],"standard_charges":[{"gross_charge":2874.0,"discounted_cash":1724.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; AXILLARY-FEMORAL-FEMORAL","code_information":[{"code":"9750978","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35533","type":"HCPCS"}],"standard_charges":[{"gross_charge":3659.0,"discounted_cash":2195.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN;AORTOILIAC","code_information":[{"code":"9750979","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35537","type":"HCPCS"}],"standard_charges":[{"gross_charge":7342.0,"discounted_cash":4405.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; AORTOBI-ILIAC","code_information":[{"code":"9750980","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35538","type":"HCPCS"}],"standard_charges":[{"gross_charge":7848.0,"discounted_cash":4708.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; AORTOFEMORAL","code_information":[{"code":"9750981","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35539","type":"HCPCS"}],"standard_charges":[{"gross_charge":5332.0,"discounted_cash":3199.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; AORTOBIFEMORAL","code_information":[{"code":"9750982","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35540","type":"HCPCS"}],"standard_charges":[{"gross_charge":6180.0,"discounted_cash":3708.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; FEMORAL-POPLITEAL","code_information":[{"code":"9750983","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35556","type":"HCPCS"}],"standard_charges":[{"gross_charge":3389.0,"discounted_cash":2033.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; FEMORAL-FEMORAL","code_information":[{"code":"9750984","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35558","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.0,"discounted_cash":1792.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; ILIOILIAC","code_information":[{"code":"9750985","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35563","type":"HCPCS"}],"standard_charges":[{"gross_charge":4442.0,"discounted_cash":2665.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH VEIN; ILIOFEMORAL","code_information":[{"code":"9750986","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35565","type":"HCPCS"}],"standard_charges":[{"gross_charge":4390.0,"discounted_cash":2634.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, W/ VEIN; FEM-ANT/POST TIBIAL","code_information":[{"code":"9750987","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35566","type":"HCPCS"}],"standard_charges":[{"gross_charge":4050.0,"discounted_cash":2430.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/VEIN; TIBIAL-TIBIAL, PERO-TIBIAL-TRUNK","code_information":[{"code":"9750988","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35570","type":"HCPCS"}],"standard_charges":[{"gross_charge":3173.0,"discounted_cash":1903.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/VEIN; POPLITEAL-TIBIAL, PERONEAL ART","code_information":[{"code":"9750989","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35571","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"discounted_cash":1929.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/ OTHER THAN VEIN;SUBCLAVIAN-AXILLARY","code_information":[{"code":"9750990","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35616","type":"HCPCS"}],"standard_charges":[{"gross_charge":2625.0,"discounted_cash":1575.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/OTHER THAN VEIN; AXILLARY-FEMORAL","code_information":[{"code":"9750991","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35621","type":"HCPCS"}],"standard_charges":[{"gross_charge":2657.0,"discounted_cash":1594.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/OTHER THAN VEIN; AXILLARY-POP OR TIB","code_information":[{"code":"9750992","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35623","type":"HCPCS"}],"standard_charges":[{"gross_charge":3191.0,"discounted_cash":1914.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH OTHER THAN; AORTOILIAC","code_information":[{"code":"9750993","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35637","type":"HCPCS"}],"standard_charges":[{"gross_charge":4182.0,"discounted_cash":2509.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GRAFT, WITH OTHER THAN VEIN; AORTOBI-ILIAC","code_information":[{"code":"9750994","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35638","type":"HCPCS"}],"standard_charges":[{"gross_charge":4260.0,"discounted_cash":2556.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/OTHER THAN VEIN;SUBCLAVIAN-VERTEBRAL","code_information":[{"code":"9750995","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35645","type":"HCPCS"}],"standard_charges":[{"gross_charge":2622.0,"discounted_cash":1573.2,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/OTHER THAN VEIN; AXILLARY-AXILLARY","code_information":[{"code":"9750996","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35650","type":"HCPCS"}],"standard_charges":[{"gross_charge":2566.0,"discounted_cash":1539.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/OTHER THAN VEIN; AXILLARY-FEM-FEM","code_information":[{"code":"9750997","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35654","type":"HCPCS"}],"standard_charges":[{"gross_charge":3300.0,"discounted_cash":1980.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT,W/OTHER THAN VEIN; FEMORAL-POPLITEAL","code_information":[{"code":"9750998","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35656","type":"HCPCS"}],"standard_charges":[{"gross_charge":2616.0,"discounted_cash":1569.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/ OTHER THAN VEIN; FEMORAL-FEMORAL","code_information":[{"code":"9750999","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35661","type":"HCPCS"}],"standard_charges":[{"gross_charge":3626.0,"discounted_cash":2175.6,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/OTHER THAN VEIN; FEM-ANT/POST TIBIAL","code_information":[{"code":"9751000","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35666","type":"HCPCS"}],"standard_charges":[{"gross_charge":3069.0,"discounted_cash":1841.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC BYPASS GFT, W/OTHER THAN VEIN;POP-TIB OR PERO ART","code_information":[{"code":"9751001","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35671","type":"HCPCS"}],"standard_charges":[{"gross_charge":2709.0,"discounted_cash":1625.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC EXP FOR POST OP HEMORRHAGE, THROMBOSIS/INF; CHEST","code_information":[{"code":"9751002","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35820","type":"HCPCS"}],"standard_charges":[{"gross_charge":6568.0,"discounted_cash":3940.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACIC LYMPHADENECTOMY BY THORACOTOMY","code_information":[{"code":"9751003","type":"CDM"},{"code":"0975","type":"RC"},{"code":"38746","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":441.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC OPEN RADIAL HEAD/NECK FRACTURE","code_information":[{"code":"9751011","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24665","type":"HCPCS"}],"standard_charges":[{"gross_charge":3215.0,"discounted_cash":1929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL PERM PACEMAKER PULSE GEN ONLY","code_information":[{"code":"9751013","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":410.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC THORACOSCOPY W/BX OF INFILATRATE;UNILAT-RT","code_information":[{"code":"9751015","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32607","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"discounted_cash":598.8,"setting":"both","modifier_code":["AS","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC THORACOSCOPY W/BX OF INFILATRATE;UNILAT-LT","code_information":[{"code":"9751016","type":"CDM"},{"code":"0975","type":"RC"},{"code":"32607","type":"HCPCS"}],"standard_charges":[{"gross_charge":998.0,"discounted_cash":598.8,"setting":"both","modifier_code":["AS","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC BYPASS GRAFT W/OTHER THAN VEIN, ILIOFEMORAL","code_information":[{"code":"9751017","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35665","type":"HCPCS"}],"standard_charges":[{"gross_charge":3390.0,"discounted_cash":2034.0,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REOP CABG/VALVE>1 MO AFTER ORIG SURG","code_information":[{"code":"9751018","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33530","type":"HCPCS"}],"standard_charges":[{"gross_charge":1724.0,"discounted_cash":1034.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC HARVEST UPP EXTREM ART 1 SEGMNT FOR CABG","code_information":[{"code":"9751019","type":"CDM"},{"code":"0975","type":"RC"},{"code":"35600","type":"HCPCS"}],"standard_charges":[{"gross_charge":844.0,"discounted_cash":506.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC REMOVAL PERM PACEMAKER GEN ONLY","code_information":[{"code":"9751021","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":684.0,"discounted_cash":410.4,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC TOTAL HIP ARTHROPLASTY-RT","code_information":[{"code":"9751023","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27130","type":"HCPCS"}],"standard_charges":[{"gross_charge":5234.0,"discounted_cash":3140.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TOTAL HIP ARTHROPLASTY-LT","code_information":[{"code":"9751024","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27130","type":"HCPCS"}],"standard_charges":[{"gross_charge":5234.0,"discounted_cash":3140.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC UPPER ARM/ELBOW SURGERY","code_information":[{"code":"9751025","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24999","type":"HCPCS"}],"standard_charges":[{"gross_charge":4566.0,"discounted_cash":2739.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX POST HIP ARTH DIS W/ANES RT","code_information":[{"code":"9751026","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.0,"discounted_cash":2149.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX POST HIP ARTH DIS W/ANES LT","code_information":[{"code":"9751027","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27266","type":"HCPCS"}],"standard_charges":[{"gross_charge":3582.0,"discounted_cash":2149.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DRAINAGE OF MOUTH LESION","code_information":[{"code":"9751028","type":"CDM"},{"code":"0975","type":"RC"},{"code":"41018","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REMOVAL FOREIGN BODY JAWBONE","code_information":[{"code":"9751029","type":"CDM"},{"code":"0975","type":"RC"},{"code":"41806","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC REPAIR TOOTH SOCKET","code_information":[{"code":"9751030","type":"CDM"},{"code":"0975","type":"RC"},{"code":"41874","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":183.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 15221 PRO FULL THICK SKIN GRAFT TO SCALP ARM &/OR LEG EA ADDL 20.0 SQ CM","code_information":[{"code":"9751031","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15221","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC FLUORO, GUIDED NEEDLE PLACEMENT-PHY","code_information":[{"code":"9751032","type":"CDM"},{"code":"0975","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC APP UNILT EXT FIX W/ADJ INC IMAG, EXCHG STRUT EA-RT","code_information":[{"code":"9751033","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20697","type":"HCPCS"}],"standard_charges":[{"gross_charge":7357.0,"discounted_cash":4414.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC APP UNILT EXT FIX W/ADJ INC IMAG, EXCHG STRUT-EA LT","code_information":[{"code":"9751034","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20697","type":"HCPCS"}],"standard_charges":[{"gross_charge":7357.0,"discounted_cash":4414.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CAPSULECTOMY HIP W OR W/O HETEROTOPIC BONE","code_information":[{"code":"9751035","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27036","type":"HCPCS"}],"standard_charges":[{"gross_charge":3727.0,"discounted_cash":2236.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC TX SLIPPED FEMORAL EPIPHYSIS SGL OR MULT PIN IN SITU","code_information":[{"code":"9751036","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27176","type":"HCPCS"}],"standard_charges":[{"gross_charge":3387.0,"discounted_cash":2032.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX FEMORAL SHAFT FX W OR W/O CERCLAGE-RT","code_information":[{"code":"9751037","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27507","type":"HCPCS"}],"standard_charges":[{"gross_charge":3606.0,"discounted_cash":2163.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX FEMORAL SHAFT FX W OR W/O CERCLAGE-LT","code_information":[{"code":"9751038","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27507","type":"HCPCS"}],"standard_charges":[{"gross_charge":3606.0,"discounted_cash":2163.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX FEM SUPRACOND OR TRANSCOND FX-RT","code_information":[{"code":"9751039","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27511","type":"HCPCS"}],"standard_charges":[{"gross_charge":3698.0,"discounted_cash":2218.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX FEM SUPRACOND OR TRANSCOND FX-LT","code_information":[{"code":"9751040","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27511","type":"HCPCS"}],"standard_charges":[{"gross_charge":3698.0,"discounted_cash":2218.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR MAL/NONUNION RADIUS OR ULNA W/O GRAFT-RT","code_information":[{"code":"9751041","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2719.0,"discounted_cash":1631.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR MAL/NONUNION RADIUS OR ULNA W/O GRAFT-LT","code_information":[{"code":"9751042","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2719.0,"discounted_cash":1631.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TENODESIS OF LONG TENDON OF BICEPS -RT","code_information":[{"code":"9751043","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23430","type":"HCPCS"}],"standard_charges":[{"gross_charge":12504.0,"discounted_cash":7502.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TENODESIS OF LONG TENDON OF BICEPS -LT","code_information":[{"code":"9751044","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23430","type":"HCPCS"}],"standard_charges":[{"gross_charge":12504.0,"discounted_cash":7502.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PARTIAL REMOVAL OF HEEL/ANKLE-RT","code_information":[{"code":"9751045","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":1058.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PARTIAL REMOVAL OF HEEL/ANKLE-LT","code_information":[{"code":"9751046","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.0,"discounted_cash":1058.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CAPSULORRHAPHY, ANT; W/CORACOID PROC TRANS-RT","code_information":[{"code":"9751055","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23462","type":"HCPCS"}],"standard_charges":[{"gross_charge":3703.0,"discounted_cash":2221.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CAPSULORRHAPHY, ANT; W/CORACOID PROC TRANS-LT","code_information":[{"code":"9751056","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23462","type":"HCPCS"}],"standard_charges":[{"gross_charge":3703.0,"discounted_cash":2221.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX SHOULDER DISLOC, W/FX, INC INT FIX-RT","code_information":[{"code":"9751057","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2566.0,"discounted_cash":1539.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX SHOULDER DISLOC, W/FX, INC INT FIX-LT","code_information":[{"code":"9751058","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23670","type":"HCPCS"}],"standard_charges":[{"gross_charge":2566.0,"discounted_cash":1539.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC LENGTHEN OR SHORTEN TENDON LEG OR ANKLE-SINGLE TENDON-RT","code_information":[{"code":"9751059","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27685","type":"HCPCS"}],"standard_charges":[{"gross_charge":1848.0,"discounted_cash":1108.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC LENGTHEN OR SHORTEN TENDON LEG OR ANKLE-SINGLE TENDON-LT","code_information":[{"code":"9751060","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27685","type":"HCPCS"}],"standard_charges":[{"gross_charge":1848.0,"discounted_cash":1108.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR NONUNION/MALUNION, RADIUS OR ULNA W/AUTOGRAFT-RT","code_information":[{"code":"9751061","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2965.0,"discounted_cash":1779.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REPAIR NONUNION/MALUNION, RADIUS OR ULNA W/AUTOGRAFT-LT","code_information":[{"code":"9751062","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25405","type":"HCPCS"}],"standard_charges":[{"gross_charge":2965.0,"discounted_cash":1779.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, ELBOW, INC EXP, DRAIN, OR REM FB-RT","code_information":[{"code":"9751065","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1621.0,"discounted_cash":972.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, ELBOW, INC EXP, DRAIN, OR REM FB-LT","code_information":[{"code":"9751066","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1621.0,"discounted_cash":972.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX DISTAL FIBULAR FX (LAT MALLEOLUS); W/MAN-RT","code_information":[{"code":"9751067","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":846.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX DISTAL FIBULAR FX (LAT MALLEOLUS); W/MAN-LT","code_information":[{"code":"9751068","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":846.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PARTIAL REMOVAL; DISTAL PHALANX OF FINGER","code_information":[{"code":"9751069","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26236","type":"HCPCS"}],"standard_charges":[{"gross_charge":4527.0,"discounted_cash":2716.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PART REMOVAL;PROXIMAL OR MIDDLE PHALANX OF FINGER","code_information":[{"code":"9751070","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26235","type":"HCPCS"}],"standard_charges":[{"gross_charge":4527.0,"discounted_cash":2716.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28490 PRO CLOSED TX OF FX GREAT TOE, PHALANX OR PHALANGES; W/O MANIPULATION","code_information":[{"code":"9751071","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28490","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28510 PRO CLOSED TREATMENT FRACTURE, OTHER THAN GREAT TOE; W/O MANIP, EA","code_information":[{"code":"9751072","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28510","type":"HCPCS"}],"standard_charges":[{"gross_charge":444.0,"discounted_cash":266.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC BONE CYST OF ILIUM/SYM PUBIS/FEM; INC GRAFT-RT","code_information":[{"code":"9751073","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.0,"discounted_cash":1047.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC EXC BONE CYST OF ILIUM/SYM PUBIS/FEM; INC GRAFT-LT","code_information":[{"code":"9751074","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27065","type":"HCPCS"}],"standard_charges":[{"gross_charge":1746.0,"discounted_cash":1047.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION OF HAND-RT","code_information":[{"code":"9751075","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25927","type":"HCPCS"}],"standard_charges":[{"gross_charge":2955.0,"discounted_cash":1773.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMPUTATION OF HAND-LT","code_information":[{"code":"9751076","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25927","type":"HCPCS"}],"standard_charges":[{"gross_charge":2955.0,"discounted_cash":1773.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC PINNING OF DISPLACED FX OF TRAPEZIUM","code_information":[{"code":"9751077","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25999","type":"HCPCS"}],"standard_charges":[{"gross_charge":7282.0,"discounted_cash":4369.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMPRESSION OF THIGH/KNEE W/DEBRIDE-RT","code_information":[{"code":"9751078","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27499","type":"HCPCS"}],"standard_charges":[{"gross_charge":2395.0,"discounted_cash":1437.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOMPRESSION OF THIGH/KNEE W/DEBRIDE-LT","code_information":[{"code":"9751079","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27499","type":"HCPCS"}],"standard_charges":[{"gross_charge":2395.0,"discounted_cash":1437.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOM FASCIOTOMY,LEG; ANT&/OR LAT COMP ONLY-RT","code_information":[{"code":"9751080","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.0,"discounted_cash":864.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOM FASCIOTOMY,LEG; ANT&/OR LAT COMP ONLY-LT","code_information":[{"code":"9751081","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.0,"discounted_cash":864.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DEBRIDEMENT, BONE, EA ADD 20 SQ CM","code_information":[{"code":"9751082","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11047","type":"HCPCS"}],"standard_charges":[{"gross_charge":384.0,"discounted_cash":230.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUTURE MAJ PERIPH NERVE, ARM OR LEG; W/O TRANS","code_information":[{"code":"9751083","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64857","type":"HCPCS"}],"standard_charges":[{"gross_charge":3655.0,"discounted_cash":2193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUTURE OF EA ADD MAJOR PERIPHERAL NERVE","code_information":[{"code":"9751084","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64859","type":"HCPCS"}],"standard_charges":[{"gross_charge":981.0,"discounted_cash":588.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLSD TX FRACTURE DISLOC AT ELBOW W/ MANIP-RT","code_information":[{"code":"9751085","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2042.0,"discounted_cash":1225.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX FRACTURE DISLOC AT ELBOW W/ MANIP-LT","code_information":[{"code":"9751086","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2042.0,"discounted_cash":1225.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SUTURE OF 1 NERVE; ULNAR MOTOR-RT","code_information":[{"code":"9751087","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64836","type":"HCPCS"}],"standard_charges":[{"gross_charge":2807.0,"discounted_cash":1684.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SUTURE OF 1 NERVE; ULNAR MOTOR-LT","code_information":[{"code":"9751088","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64836","type":"HCPCS"}],"standard_charges":[{"gross_charge":2807.0,"discounted_cash":1684.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX DISTAL FEMORAL EPIPHYSEAL SEP W/MAN-RT","code_information":[{"code":"9751089","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27517","type":"HCPCS"}],"standard_charges":[{"gross_charge":2567.0,"discounted_cash":1540.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TX DISTAL FEMORAL EPIPHYSEAL SEP W/MAN-LT","code_information":[{"code":"9751090","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27517","type":"HCPCS"}],"standard_charges":[{"gross_charge":2567.0,"discounted_cash":1540.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29075 PRO APPLICATION CAST ELBOW TO FINGER RT","code_information":[{"code":"9751091","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":205.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29075 PRO APPLICATION CAST ELBOW TO FINGER LT","code_information":[{"code":"9751092","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":205.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX DISTAL FEMORAL EPIPH SEP, INC INT FIX-RT","code_information":[{"code":"9751093","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27519","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":2004.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX DISTAL FEMORAL EPIPH SEP, INC INT FIX-LT","code_information":[{"code":"9751094","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27519","type":"HCPCS"}],"standard_charges":[{"gross_charge":3341.0,"discounted_cash":2004.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLSD TREATMENT OF COCCYGEAL FRACTURE","code_information":[{"code":"9751095","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27200","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.0,"discounted_cash":388.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC FIX CARPOMETACARPAL FX DISCLOC THUMB W/MAN-RT","code_information":[{"code":"9751096","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":765.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PERC FIX CARPOMETACARPAL FX DISCLOC THUMB W/MAN-LT","code_information":[{"code":"9751097","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1275.0,"discounted_cash":765.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TENOLYSIS, FLEX OR EXTEN TENDON, LEG/ANKLE; EA TENDON-RT","code_information":[{"code":"9751098","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1400.0,"discounted_cash":840.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TENOLYSIS, FLEX OR EXTEN TENDON, LEG/ANKLE; EA TENDON-LT","code_information":[{"code":"9751099","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27680","type":"HCPCS"}],"standard_charges":[{"gross_charge":1400.0,"discounted_cash":840.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TREAT TOE DISLOCATION WITH MANIPULATION","code_information":[{"code":"9751100","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28666","type":"HCPCS"}],"standard_charges":[{"gross_charge":626.0,"discounted_cash":375.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20605 PRO DRAIN/INJECT INTERMEDIATE JOINT/BURSA W/O US GUIDE-RT","code_information":[{"code":"9751101","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20605 PRO DRAIN/INJECT INTERMEDIATE JOINT/BURSA W/O US GUIDE-LT","code_information":[{"code":"9751102","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO NEGATIVE PRESSURE WOUND TX <50 SQ CM-UTILIZE DME","code_information":[{"code":"9751103","type":"CDM"},{"code":"0975","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":115.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO ARTHRO,ASP/INJ MAJOR JOINT/BURSA; WO GUIDE-RT","code_information":[{"code":"9751104","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO ARTHRO,ASP/INJ MAJOR JOINT/BURSA; WO GUIDE-LT","code_information":[{"code":"9751105","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO ARTHROCENTESIS, MAJOR JT/BURSA/GAN; WO GUIDE","code_information":[{"code":"9751106","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":252.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO PT NEGATIVE PRESSURE WOUND TX >50 SQ CM-UTILIZE DME","code_information":[{"code":"9751107","type":"CDM"},{"code":"0975","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":222.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO OPEN TX ANKLE FX, INC INT FIX; W/ FIX OF POST LIP-RT","code_information":[{"code":"9751108","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27823","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":1890.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO OPEN TX ANKLE FX, INC INT FIX; W/ FIX OF POST LIP-LT","code_information":[{"code":"9751109","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27823","type":"HCPCS"}],"standard_charges":[{"gross_charge":3150.0,"discounted_cash":1890.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO REPAIR FLEXOR TENDON, LEG; W/OUT GRAFT, EA TEND-RT","code_information":[{"code":"9751110","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27658","type":"HCPCS"}],"standard_charges":[{"gross_charge":1219.0,"discounted_cash":731.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO REPAIR FLEXOR TENDON, LEG; W/OUT GRAFT, EA TEND-LT","code_information":[{"code":"9751111","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27658","type":"HCPCS"}],"standard_charges":[{"gross_charge":1219.0,"discounted_cash":731.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX POST MALLEOLUS FX, INC INT FIX- RT","code_information":[{"code":"9751112","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2399.0,"discounted_cash":1439.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC OPEN TX POST MALLEOLUS FX, INC INT FIX- LT","code_information":[{"code":"9751113","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2399.0,"discounted_cash":1439.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC EXC, TUMOR, HAND &/OR FINGER, SUBQ; 1.5CM OR MORE","code_information":[{"code":"9751114","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1136.0,"discounted_cash":681.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC, TUMOR HAND &/OR FINGER, SUBFASCIAL; 1.5CM OR MORE","code_information":[{"code":"9751115","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26113","type":"HCPCS"}],"standard_charges":[{"gross_charge":1486.0,"discounted_cash":891.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC, TUMOR, HAND &/OR FINGER, SUBQ; LESS THAN 1.5 CM","code_information":[{"code":"9751116","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26115","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.0,"discounted_cash":537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC EXC, TUMOR HAND &/OR FINGER, SUBFASCIAL; LESS THAN 1.5 CM","code_information":[{"code":"9751117","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26116","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"discounted_cash":856.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY W/ BIOPSY; METACARPOPHALANGEAL JT, EA","code_information":[{"code":"9751118","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26105","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":636.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC CLOSED TX HIP DISLOC TRAUMA WITH ANES - RT","code_information":[{"code":"9751119","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2207.0,"discounted_cash":1324.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLOSED TX HIP DISLOC TRAUMA WITH ANES - LT","code_information":[{"code":"9751120","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27252","type":"HCPCS"}],"standard_charges":[{"gross_charge":2207.0,"discounted_cash":1324.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOM FASCIOTOMY, FOREARM &/OR WRIST; W/ DEBRIDE","code_information":[{"code":"9751121","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25023","type":"HCPCS"}],"standard_charges":[{"gross_charge":2898.0,"discounted_cash":1738.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC OPEN TX ARTIC FX, METACARP OR INTERPHAL JT, W/INT FIX, EA","code_information":[{"code":"9751122","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26746","type":"HCPCS"}],"standard_charges":[{"gross_charge":1954.0,"discounted_cash":1172.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PERC FIX METACARPOPPHALANGEAL DISLOC SGL W/MAN","code_information":[{"code":"9751123","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":683.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC DECOMP FASCIOTOMY, FOREARM / WRIST W/O DEBRIDE-RT","code_information":[{"code":"9751124","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25024","type":"HCPCS"}],"standard_charges":[{"gross_charge":2079.0,"discounted_cash":1247.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOMP FASCIOTOMY, FOREARM / WRIST W/O DEBRIDE-LT","code_information":[{"code":"9751125","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25024","type":"HCPCS"}],"standard_charges":[{"gross_charge":2079.0,"discounted_cash":1247.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLOSED TX LUNATE DISLOCATION, W/MANIPULATION-RT","code_information":[{"code":"9751126","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC CLOSED TX LUNATE DISLOCATION, W/MANIPULATION-LT","code_information":[{"code":"9751127","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25690","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.0,"discounted_cash":763.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP FEMUR, DISTAL TO HEAL & NECK; W/BONE GRAFT-RT","code_information":[{"code":"9751128","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27472","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":2220.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP FEMUR, DISTAL TO HEAL & NECK; W/BONE GRAFT-LT","code_information":[{"code":"9751129","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27472","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":2220.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC TENOTOMY SHOULDER AREA SINGLE TENDON","code_information":[{"code":"9751130","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1668.0,"discounted_cash":1000.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO OPEN TX METACARPOPHALANG DISLOC, SGL, INC INT FIX","code_information":[{"code":"9751131","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26715","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.0,"discounted_cash":902.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO LIGATION, MAJ ART (POST-TRAUMATIC, RUPTURE) EXT-RT","code_information":[{"code":"9751132","type":"CDM"},{"code":"0975","type":"RC"},{"code":"37618","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":685.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO LIGATION, MAJ ART (POST-TRAUMATIC, RUPTURE); EXT-LT","code_information":[{"code":"9751133","type":"CDM"},{"code":"0975","type":"RC"},{"code":"37618","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.0,"discounted_cash":685.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO TRANSECTION OR AVULSION OTHER SPINAL NERVE, EXT","code_information":[{"code":"9751134","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1837.0,"discounted_cash":1102.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO INITIAL CRITICAL CARE, 28 DAYS OF AGE OR YOUNGER","code_information":[{"code":"9751135","type":"CDM"},{"code":"0975","type":"RC"},{"code":"99468","type":"HCPCS"}],"standard_charges":[{"gross_charge":2615.0,"discounted_cash":1569.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO SUBSEQUENT CRITICAL CARE, 28 DAYS OR YOUNGER","code_information":[{"code":"9751136","type":"CDM"},{"code":"0975","type":"RC"},{"code":"99469","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.0,"discounted_cash":679.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO INITIAL INTENSIVE CARE, 28 DAYS OF AGE OR LESS","code_information":[{"code":"9751137","type":"CDM"},{"code":"0975","type":"RC"},{"code":"99477","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1232.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO SUBSEQUENT INTENSIVE CARE, PRESENT WT <1,500 GM","code_information":[{"code":"9751138","type":"CDM"},{"code":"0975","type":"RC"},{"code":"99478","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.0,"discounted_cash":242.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO SUBSEQUENT INTENSIVE CARE, PRESENT WT 1,500-2,500 GM","code_information":[{"code":"9751139","type":"CDM"},{"code":"0975","type":"RC"},{"code":"99479","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.0,"discounted_cash":213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO SUBSEQUENT INTENSIVE CARE, PRESENT WT 2,501-5,000 GM","code_information":[{"code":"9751140","type":"CDM"},{"code":"0975","type":"RC"},{"code":"99480","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":204.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION","code_information":[{"code":"9751141","type":"CDM"},{"code":"0975","type":"RC"},{"code":"31515","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORN","code_information":[{"code":"9751142","type":"CDM"},{"code":"0975","type":"RC"},{"code":"36510","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.0,"discounted_cash":85.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE-RT","code_information":[{"code":"9751143","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.0,"discounted_cash":1093.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE-LT","code_information":[{"code":"9751144","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27385","type":"HCPCS"}],"standard_charges":[{"gross_charge":1823.0,"discounted_cash":1093.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC INSERT TISSUE EXPANDER FOR OTHER THAN BREAST INC SUB","code_information":[{"code":"9751145","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11960","type":"HCPCS"}],"standard_charges":[{"gross_charge":3777.0,"discounted_cash":2266.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO REMOVAL FB, DEEP THIGH REGION OR KNEE AREA","code_information":[{"code":"9751146","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27372","type":"HCPCS"}],"standard_charges":[{"gross_charge":2362.0,"discounted_cash":1417.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO SUTURE OF 1 NERVE, MEDIAN MOTOR THENAR RT","code_information":[{"code":"9751149","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64835","type":"HCPCS"}],"standard_charges":[{"gross_charge":2640.0,"discounted_cash":1584.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO SUTURE OF 1 NERVE, MEDIAN MOTOR THENAR LT","code_information":[{"code":"9751150","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64835","type":"HCPCS"}],"standard_charges":[{"gross_charge":2957.0,"discounted_cash":1774.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO INC (EG, OSTEO OR BONE ABS) LEG OR ANKLE - RT","code_information":[{"code":"9751151","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1950.0,"discounted_cash":1170.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO INC (EG, OSTEO OR BONE ABS) LEG OR ANKLE - LT","code_information":[{"code":"9751152","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1950.0,"discounted_cash":1170.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOMP FASCIOTOMY FOREARM &/OR WRIST W DEBRIDE RT","code_information":[{"code":"9751153","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25025","type":"HCPCS"}],"standard_charges":[{"gross_charge":4194.0,"discounted_cash":2516.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC DECOMP FASCIOTOMY FOREARM &/OR WRIST W DEBRIDE LT","code_information":[{"code":"9751154","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25025","type":"HCPCS"}],"standard_charges":[{"gross_charge":4194.0,"discounted_cash":2516.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PROPHY TX W OR W/O METHYLMETHACRYLATE, FEMUR-RT","code_information":[{"code":"9751155","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27495","type":"HCPCS"}],"standard_charges":[{"gross_charge":3934.0,"discounted_cash":2360.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PROPHY TX W OR W/O METHYLMETHACRYLATE, FEMUR-LT","code_information":[{"code":"9751156","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27495","type":"HCPCS"}],"standard_charges":[{"gross_charge":3934.0,"discounted_cash":2360.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BIOPSY, SOFT TISSUE THIGH OR KNEE AREA; DEEP-RT","code_information":[{"code":"9751157","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27324","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":761.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC BIOPSY, SOFT TISSUE THIGH OR KNEE AREA; DEEP-LT","code_information":[{"code":"9751158","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27324","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.0,"discounted_cash":761.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, ANKLE, INC EXP, DRAIN OR REM FB-RT","code_information":[{"code":"9751159","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27610","type":"HCPCS"}],"standard_charges":[{"gross_charge":8092.0,"discounted_cash":4855.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY, ANKLE, INC EXP, DRAIN OR REM FB-LT","code_information":[{"code":"9751160","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27610","type":"HCPCS"}],"standard_charges":[{"gross_charge":8092.0,"discounted_cash":4855.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP DISLOC PERONEAL TENDONS; W/O FIBULAR OSTEO-RT","code_information":[{"code":"9751161","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27675","type":"HCPCS"}],"standard_charges":[{"gross_charge":8092.0,"discounted_cash":4855.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC REP DISLOC PERONEAL TENDONS; W/O FIBULAR OSTEO-LT","code_information":[{"code":"9751162","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27675","type":"HCPCS"}],"standard_charges":[{"gross_charge":8092.0,"discounted_cash":4855.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC FASCIECTOMY, PLANTAR FASCIA; PARTIAL-RT","code_information":[{"code":"9751163","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28060","type":"HCPCS"}],"standard_charges":[{"gross_charge":4916.0,"discounted_cash":2949.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC FASCIECTOMY, PLANTAR FASCIA; PARTIAL-LT","code_information":[{"code":"9751164","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28060","type":"HCPCS"}],"standard_charges":[{"gross_charge":4916.0,"discounted_cash":2949.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28122 PRO PART REM OF TARSAL OR METAT BONE EXCEPT TALUS-RT","code_information":[{"code":"9751165","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1868.0,"discounted_cash":1120.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28122 PRO PART REM OF TARSAL OR METAT BONE EXCEPT TALUS-LT","code_information":[{"code":"9751166","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28122","type":"HCPCS"}],"standard_charges":[{"gross_charge":1868.0,"discounted_cash":1120.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28270 PRO CAPSULOTOMY; METATARSOPHAL JT, W OR W/O TENORRHAPHY, EA JOINT","code_information":[{"code":"9751167","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1525.0,"discounted_cash":915.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28285 PRO CORRECTION, HAMMERTOE (FUSION, PARTIAL OR TOTAL)","code_information":[{"code":"9751168","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.0,"discounted_cash":996.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28750 PRO ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT","code_information":[{"code":"9751169","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2541.0,"discounted_cash":1524.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC ARTHROTOMY OF THE ELBOW, W/ CAPSULAR EXCISION-RT","code_information":[{"code":"9751170","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.0,"discounted_cash":1125.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC ARTHROTOMY OF THE ELBOW, W/ CAPSULAR EXCISION-LT","code_information":[{"code":"9751171","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.0,"discounted_cash":1125.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC AMP, FGR OR THUMB, PRIMARY OR 2NDARY, ANY JT SGL","code_information":[{"code":"9751172","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26952","type":"HCPCS"}],"standard_charges":[{"gross_charge":1646.0,"discounted_cash":987.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28297 PRO CORRECTION,HALLUX VALGUS,W/WO SESMOIDECTOMY","code_information":[{"code":"9751173","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28297","type":"HCPCS"}],"standard_charges":[{"gross_charge":1547.0,"discounted_cash":928.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28300 PRO OSTEOTOMY; CALCANEUS,W/WO INTERNAL FIXATION","code_information":[{"code":"9751174","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1737.0,"discounted_cash":1042.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28298 PRO CORRECT,HALLUX VALGUS, W/WO SESAMOIDECTOMY; BY PHALANX OSTEOTOMY-RT","code_information":[{"code":"9751175","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":805.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28298 PRO CORRECT,HALLUX VALGUS, W/WO SESAMOIDECTOMY; BY PHALANX OSTEOTOMY-LT","code_information":[{"code":"9751176","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28298","type":"HCPCS"}],"standard_charges":[{"gross_charge":1342.0,"discounted_cash":805.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28299 PRO CORRECTION,HALLUX VALGUS, W/WO SESAMOIDECTOMY; BY DOUBLE OSTEOTOMY-RT","code_information":[{"code":"9751177","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1800.0,"discounted_cash":1080.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28299 PRO CORRECTION,HALLUX VALGUS, W/WO SESAMOIDECTOMY; BY DOUBLE OSTEOTOMY-LT","code_information":[{"code":"9751178","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1800.0,"discounted_cash":1080.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO ENDOSCOPIC PLANTAR FASCIOTOMY","code_information":[{"code":"9751179","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1576.0,"discounted_cash":945.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO CORRECT, HALLUX RIGD W/ CHEIL, DEBRD & CAP RELS-1ST METPHAL JNT","code_information":[{"code":"9751180","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28289","type":"HCPCS"}],"standard_charges":[{"gross_charge":1911.0,"discounted_cash":1146.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28740 PRO ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT","code_information":[{"code":"9751181","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1984.0,"discounted_cash":1190.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27690 PRO TRANSFER/TRANSPLANT 1 TENDON W MUSCLE REDIRECT/REROUTE; SUPERFICIAL","code_information":[{"code":"9751182","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27690","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.0,"discounted_cash":898.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27687 PRO GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)","code_information":[{"code":"9751183","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27687","type":"HCPCS"}],"standard_charges":[{"gross_charge":1497.0,"discounted_cash":898.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27650 PRO REPAIR PRIMARY, OPEN OR PERCUTANEOUS RUPTURED ACHILLES TENDON","code_information":[{"code":"9751184","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":942.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28124 PRO PARTIAL EXCISION BONE; PHALANX OF TOE-RT","code_information":[{"code":"9751185","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":664.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28124 PRO PARTIAL EXCISION BONE; PHALANX OF TOE-RT","code_information":[{"code":"9751186","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28124","type":"HCPCS"}],"standard_charges":[{"gross_charge":1108.0,"discounted_cash":664.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28043 PRO EXCISION, TUMOR, SOFT TISSUE OF FOOT/TOE, SUBQ; < 1.5 CM-RT","code_information":[{"code":"9751187","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28043","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":558.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28043 PRO EXCISION, TUMOR, SOFT TISSUE OF FOOT/TOE, SUBQ; < 1.5 CM-LT","code_information":[{"code":"9751188","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28043","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":558.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28090 PRO EXCISION LESION, TENDON, TENDON SHEATH/CAPSULE W SYNOVECTOMY; FOOT-RT","code_information":[{"code":"9751189","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":655.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28090 PRO EXCISION LESION, TENDON, TENDON SHEATH/CAPSULE W SYNOVECTOMY; FOOT-LT","code_information":[{"code":"9751190","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28090","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.0,"discounted_cash":655.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64782 PRO EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE-RT","code_information":[{"code":"9751191","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64782","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":645.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64782 PRO EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE-LT","code_information":[{"code":"9751192","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64782","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":645.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO APP HIGH COST SKIN SUB FACE,HAND,FEET,GENITAL 1ST 25 SQ CM","code_information":[{"code":"9751193","type":"CDM"},{"code":"0975","type":"RC"},{"code":"15275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC PRO TENOTOMY, OPEN, FLEXOR/EXTENSOR TENDON, EA-RT","code_information":[{"code":"9751194","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":604.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO TENOTOMY, OPEN, FLEXOR/EXTENSOR TENDON, EA-LT","code_information":[{"code":"9751195","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":604.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO REPAIR SECONDARY, ACHILLES TENDN W/ OR W/O GRAFT-RT","code_information":[{"code":"9751196","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27654","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":989.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO REPAIR SECONDARY, ACHILLES TENDN W/ OR W/O GRAFT-LT","code_information":[{"code":"9751197","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27654","type":"HCPCS"}],"standard_charges":[{"gross_charge":1649.0,"discounted_cash":989.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO GASTROCNEMIUS RECESSION (EG, STRAYER PROCD)-RT","code_information":[{"code":"9751198","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27687","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":636.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO GASTROCNEMIUS RECESSION (EG, STRAYER PROCD)-LT","code_information":[{"code":"9751199","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27687","type":"HCPCS"}],"standard_charges":[{"gross_charge":1060.0,"discounted_cash":636.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO OSTEOTOMY, +/- CORRECTION, METATARSAL; 2-5 EA-RT","code_information":[{"code":"9751200","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":772.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO OSTEOTOMY, +/- CORRECTION, METATARSAL; 2-5 EA-LT","code_information":[{"code":"9751201","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.0,"discounted_cash":772.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27197 PRO CLSD POST PELVIC RING FX/DISL,W/O MANIP","code_information":[{"code":"9751202","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27197","type":"HCPCS"}],"standard_charges":[{"gross_charge":2190.0,"discounted_cash":1314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27198 PRO CLSD POST PELVIC RING FX/DISL,W/MANIP","code_information":[{"code":"9751203","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27198","type":"HCPCS"}],"standard_charges":[{"gross_charge":3295.0,"discounted_cash":1977.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28291 PRO CORRECT,HALLUX RIGD W/CHEIL,DEBRD & CAP RELS-1ST METPHAL JT,W/IMPLNT","code_information":[{"code":"9751204","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1911.0,"discounted_cash":1146.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28295 PRO CORRECT,HALLUX VALGUS,W/WO SESAMOIDCTMY BY PROX METATRSL OSTEOTOMY","code_information":[{"code":"9751205","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28295","type":"HCPCS"}],"standard_charges":[{"gross_charge":2425.0,"discounted_cash":1455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 33390 VALVULOPLASTY,AORTIC VALVE;OPEN W/BYPASS,SIMPLE","code_information":[{"code":"9751206","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33390","type":"HCPCS"}],"standard_charges":[{"gross_charge":7453.0,"discounted_cash":4471.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC 33391 VALVULOPLASTY,AORTIC VALVE;OPEN W/BYPASS,COMPLEX","code_information":[{"code":"9751207","type":"CDM"},{"code":"0975","type":"RC"},{"code":"33391","type":"HCPCS"}],"standard_charges":[{"gross_charge":7453.0,"discounted_cash":4471.8,"setting":"both","modifier_code":["AS"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery"}]},{"description":"HC 20612 PRO ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION","code_information":[{"code":"9751208","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20612","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26540 PRO REPR COLL LIGMT, METACARP OR INTRPHALGL JNT","code_information":[{"code":"9751209","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1675.0,"discounted_cash":1005.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28238 PRO RECNST PT TIB TENDN W/ EXCSN OF NVCULR BONE","code_information":[{"code":"9751210","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28238","type":"HCPCS"}],"standard_charges":[{"gross_charge":1292.0,"discounted_cash":775.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27552 PRO CLSD TX KNEE DISLOCATION; REQ ANESTHESIA - RT","code_information":[{"code":"9751211","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.0,"discounted_cash":1075.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27552 PRO CLSD TX KNEE DISLOCATION; REQ ANESTHESIA - LT","code_information":[{"code":"9751212","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1792.0,"discounted_cash":1075.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28035 PRO RELEASE, TARS TUNL-POST TIB NRV DECOMPR","code_information":[{"code":"9751213","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":822.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28116 PRO OSTECTOMY, EXCISION OF TARSAL COALITION","code_information":[{"code":"9751214","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28116","type":"HCPCS"}],"standard_charges":[{"gross_charge":1990.0,"discounted_cash":1194.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28118 PRO OSTECTOMY, CALCANEUS","code_information":[{"code":"9751215","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28118","type":"HCPCS"}],"standard_charges":[{"gross_charge":1541.0,"discounted_cash":924.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25670 PRO OPEN TX RADIOCARPAL/INTERCARPAL DISCL 1+ BONES RT","code_information":[{"code":"9751216","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":964.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25670 PRO OPEN TX RADIOCARPAL/INTERCARPAL DISCL 1+ BONES LT","code_information":[{"code":"9751217","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1607.0,"discounted_cash":964.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27676 PRO REPAIR, DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY","code_information":[{"code":"9751218","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27676","type":"HCPCS"}],"standard_charges":[{"gross_charge":1618.0,"discounted_cash":970.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28232 PRO TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROC)","code_information":[{"code":"9751219","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28232","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":601.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20103 PRO EXPLORE PENETRATING WOUND EXTREMITY","code_information":[{"code":"9751220","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20103","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.0,"discounted_cash":976.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24560 PRO CLSD HUM EPICONDYLAR FX W/O MANIP BIL","code_information":[{"code":"9751221","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1341.0,"discounted_cash":804.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 24560 PRO CLSD HUM EPICONDYLAR FX W/O MANIP RT","code_information":[{"code":"9751222","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.0,"discounted_cash":536.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24560 PRO CLSD HUM EPICONDYLAR FX W/O MANIP LT","code_information":[{"code":"9751223","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24560","type":"HCPCS"}],"standard_charges":[{"gross_charge":894.0,"discounted_cash":536.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28313 PRO RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURE ONLY","code_information":[{"code":"9751224","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28313","type":"HCPCS"}],"standard_charges":[{"gross_charge":1371.0,"discounted_cash":822.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28192 PRO REMOVAL OF FOREIGN BODY, FOOT; DEEP - LT","code_information":[{"code":"9751225","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":730.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28192 PRO REMOVAL OF FOREIGN BODY, FOOT; DEEP - RT","code_information":[{"code":"9751226","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":730.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 10121 PRO INCISION & REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED","code_information":[{"code":"9751227","type":"CDM"},{"code":"0975","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.0,"discounted_cash":421.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29898 PRO ARTHROSCOPY, ANKLE, SURGICAL; DEBRIDEMENT, EXTENSIVE-LT","code_information":[{"code":"9751228","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2656.0,"discounted_cash":1593.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29898 PRO ARTHROSCOPY, ANKLE, SURGICAL; DEBRIDEMENT, EXTENSIVE-RT","code_information":[{"code":"9751229","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2656.0,"discounted_cash":1593.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28296 PRO CORRECTION, HALLUX VALGUS, W SESAMOIDECTOMY; W DISTAL METATARSAL OSTEOTOMY","code_information":[{"code":"9751230","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28296","type":"HCPCS"}],"standard_charges":[{"gross_charge":2355.0,"discounted_cash":1413.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29105 PRO APPLIC LONG ARM SPLINT SHOULDER HAND RT","code_information":[{"code":"9751231","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":148.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29105 PRO APPLIC LONG ARM SPLINT SHOULDER HAND LT","code_information":[{"code":"9751232","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":148.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25118 PRO SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT LT","code_information":[{"code":"9751233","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25118","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":601.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25118 PRO SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLE COMPARTMENT RT","code_information":[{"code":"9751234","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25118","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.0,"discounted_cash":601.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 PRO APPLICATION SHORT ARM SPLINT (FOREARM TO HAND) STATIC RT","code_information":[{"code":"9751235","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":108.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29125 PRO APPLICATION SHORT ARM SPLINT (FOREARM TO HAND) STATIC LT","code_information":[{"code":"9751236","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":108.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27380 PRO SUTURE OF INFRAPATELLAR TENDON; PRIMARY RT","code_information":[{"code":"9751237","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":942.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27380 PRO SUTURE OF INFRAPATELLAR TENDON; PRIMARY LT","code_information":[{"code":"9751238","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1570.0,"discounted_cash":942.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27232 PRO CLTX FEM FX PROX END NCK W/MAN W/WO SKEL TRCTN RT","code_information":[{"code":"9751239","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27232","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1311.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27232 PRO CLTX FEM FX PROX END NCK W/MAN W/WO SKEL TRCTN LT","code_information":[{"code":"9751240","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27232","type":"HCPCS"}],"standard_charges":[{"gross_charge":2185.0,"discounted_cash":1311.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28760 PRO ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK RT","code_information":[{"code":"9751241","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28760","type":"HCPCS"}],"standard_charges":[{"gross_charge":2079.0,"discounted_cash":1247.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28760 PRO ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK LT","code_information":[{"code":"9751242","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28760","type":"HCPCS"}],"standard_charges":[{"gross_charge":2079.0,"discounted_cash":1247.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28320 PRO REPAIR, NONUNION OR MALUNION; TARSAL BONES-LT","code_information":[{"code":"9751243","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.0,"discounted_cash":979.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28320 PRO REPAIR, NONUNION OR MALUNION; TARSAL BONES-RT","code_information":[{"code":"9751244","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.0,"discounted_cash":979.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20551 PRO INJECTION(S); SINGLE TENDON ORIGIN/INSERTION","code_information":[{"code":"9751245","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20551","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20604 PRO ARTHOCENTESIS, ASPIRATION &/OR INJ, SM JNT/BURSA; W US, REC/RPT-LT","code_information":[{"code":"9751246","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20604 PRO ARTHOCENTESIS, ASPIRATION &/OR INJ, SM JNT/BURSA; W US, REC/RPT-RT","code_information":[{"code":"9751247","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20606 PRO ARTHOCENTESIS, ASPIRATION/INJECT, INTRM JNT/BURSA; W US, REC/RPT-LT","code_information":[{"code":"9751248","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20606 PRO ARTHOCENTESIS, ASPIRATION/INJECT, INTRM JNT/BURSA; W US, REC/RPT-RT","code_information":[{"code":"9751249","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28234 PRO TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON","code_information":[{"code":"9751250","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28234","type":"HCPCS"}],"standard_charges":[{"gross_charge":1056.0,"discounted_cash":633.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28515 PRO CLOSED TX OF FX, PHAL, OTHER THAN GREAT TOE; WITH MANIPULATION, EA","code_information":[{"code":"9751251","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.0,"discounted_cash":273.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28530 PRO CLOSED TREATMENT OF SESAMOID FRACTURE-LT","code_information":[{"code":"9751252","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28530 PRO CLOSED TREATMENT OF SESAMOID FRACTURE-RT","code_information":[{"code":"9751253","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":195.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28530 PRO CLOSED TREATMENT OF SESAMOID FRACTURE-BILAT","code_information":[{"code":"9751254","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28530","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 24400 PRO OSTEOTOMY,HUMERUS,W/WO INTERNAL FIXATION RT","code_information":[{"code":"9751255","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":1323.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24400 PRO OSTEOTOMY,HUMERUS,W/WO INTERNAL FIXATION LT","code_information":[{"code":"9751256","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":1323.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24579 PRO OPEN TRTMNT OF HUM CNDYLR FX,MED/LAT INC INTRNL FIXATION PERFM RT","code_information":[{"code":"9751257","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24579","type":"HCPCS"}],"standard_charges":[{"gross_charge":2226.0,"discounted_cash":1335.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24579 PRO OPEN TRTMNT OF HUM CNDYLR FX,MED/LAT INC INTRNL FIXATION PERFM LT","code_information":[{"code":"9751258","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24579","type":"HCPCS"}],"standard_charges":[{"gross_charge":2226.0,"discounted_cash":1335.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 10061 PRO I & D  ABSCESS COMPLICATED/ MULTIPLE","code_information":[{"code":"9751259","type":"CDM"},{"code":"0975","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":379.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64893 PRO NERVE GRAFT, SINGLE STRAND, ARM/LEG > 4CM","code_information":[{"code":"9751260","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":742.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24545 PRO OPEN TX HUMERAL SUPRACONDYLAR W/O INTERCONDYLAR EXTEN LT","code_information":[{"code":"9751261","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2702.0,"discounted_cash":1621.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24545 PRO OPEN TX HUMERAL SUPRACONDYLAR W/O INTERCONDYLAR EXTEN RT","code_information":[{"code":"9751262","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24545","type":"HCPCS"}],"standard_charges":[{"gross_charge":2702.0,"discounted_cash":1621.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25107 PRO ARTHRTMY DISTL RADILNR JNT INCL RPR TRINGLR CRTLG CMPLX","code_information":[{"code":"9751263","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25107","type":"HCPCS"}],"standard_charges":[{"gross_charge":2282.0,"discounted_cash":1369.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36465 PRO INJ NONCMPND SCLEROSANT SNGL INCOMPTNT VEIN","code_information":[{"code":"9751275","type":"CDM"},{"code":"0975","type":"RC"},{"code":"36465","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.0,"discounted_cash":1514.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36466 PRO INJ NONCMPND SCLEROSANT MULTI INCOMPTNT VEINS","code_information":[{"code":"9751276","type":"CDM"},{"code":"0975","type":"RC"},{"code":"36466","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.0,"discounted_cash":1514.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 36468 PRO INJ SCLEROSCANT FOR SPIDER VEINS, LIMB OR TRUNK","code_information":[{"code":"9751277","type":"CDM"},{"code":"0975","type":"RC"},{"code":"36468","type":"HCPCS"}],"standard_charges":[{"gross_charge":5046.0,"discounted_cash":3027.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28039 PRO EXCISION TUMOR/TISS FOOT/TOE SUBQ >1.5 CM RT","code_information":[{"code":"9751286","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":1755.0,"discounted_cash":1053.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28039 PRO EXCISION TUMOR/TISS FOOT/TOE SUBQ >1.5 CM LT","code_information":[{"code":"9751287","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28039","type":"HCPCS"}],"standard_charges":[{"gross_charge":1755.0,"discounted_cash":1053.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28062 PRO FASCIETOMY PLANTAR FASCIA RADICAL RT","code_information":[{"code":"9751288","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28062","type":"HCPCS"}],"standard_charges":[{"gross_charge":1879.0,"discounted_cash":1127.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28062 PRO FASCIETOMY PLANTAR FASCIA RADICAL LT","code_information":[{"code":"9751289","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28062","type":"HCPCS"}],"standard_charges":[{"gross_charge":1879.0,"discounted_cash":1127.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27254 PRO OPEN TREATMENT HIP DISCLOCATION TRAUMATIC RT","code_information":[{"code":"9751290","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27254","type":"HCPCS"}],"standard_charges":[{"gross_charge":4476.0,"discounted_cash":2685.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27254 PRO OPEN TREATMENT HIP DISCLOCATION TRAUMATIC LT","code_information":[{"code":"9751291","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27254","type":"HCPCS"}],"standard_charges":[{"gross_charge":4476.0,"discounted_cash":2685.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28725 PRO ARTHRODESIS SUBTALAR LT","code_information":[{"code":"9751292","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2760.0,"discounted_cash":1656.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28725 PRO ARTHRODESIS SUBTALAR LT","code_information":[{"code":"9751293","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2760.0,"discounted_cash":1656.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28730 PRO ARTHRODESIS MIDTARS/TARSOMETTARS LT","code_information":[{"code":"9751294","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2557.0,"discounted_cash":1534.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28730 PRO ARTHRODESIS MIDTARS/TARSOMETTARS RT","code_information":[{"code":"9751295","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2557.0,"discounted_cash":1534.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29897 PRO ARTHROSCOPY ANKLE DEBRID LT","code_information":[{"code":"9751296","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29897","type":"HCPCS"}],"standard_charges":[{"gross_charge":2067.0,"discounted_cash":1240.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29897 PRO ARTHROSCOPY ANKLE DEBRID RT","code_information":[{"code":"9751297","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29897","type":"HCPCS"}],"standard_charges":[{"gross_charge":2067.0,"discounted_cash":1240.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28306 PRO OSTEOTOMY FIRST METATARSAL LT","code_information":[{"code":"9751298","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.0,"discounted_cash":996.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28306 PRO OSTEOTOMY FIRST METATARSAL RT","code_information":[{"code":"9751299","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.0,"discounted_cash":996.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27768 PRO CLSD TX POSTERIOR MALL FX W/MAN LT","code_information":[{"code":"9751300","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1418.0,"discounted_cash":850.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27768 PRO CLSD TX POSTERIOR MALL FX W/MAN RT","code_information":[{"code":"9751301","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1418.0,"discounted_cash":850.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27831 PRO CLSD TX PROX TIBFIB JOINT DISLOC, REQ ANEST RT","code_information":[{"code":"9751302","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27831","type":"HCPCS"}],"standard_charges":[{"gross_charge":4353.0,"discounted_cash":2611.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27831 PRO CLSD TX PROX TIBFIB JOINT DISLOC, REQ ANEST LT","code_information":[{"code":"9751303","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27831","type":"HCPCS"}],"standard_charges":[{"gross_charge":4353.0,"discounted_cash":2611.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27605 TENOTOMY PERCU ACHILLES TEND LOC ANES-RT","code_information":[{"code":"9751304","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":658.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27605 TENOTOMY PERCU ACHILLES TEND LOC ANES-LT","code_information":[{"code":"9751305","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":658.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27605 TENOTOMY PERCU ACHILLES TEND LOC ANES-BLT","code_information":[{"code":"9751306","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1785.0,"discounted_cash":1071.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29875 PRO ARTHROSCOPY KNEE SYNOVECTOMY LIMITED LT","code_information":[{"code":"9751307","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29875","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.0,"discounted_cash":1450.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29875 PRO ARTHROSCOPY KNEE SYNOVECTOMY LIMITED RT","code_information":[{"code":"9751308","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29875","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.0,"discounted_cash":1450.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23470 PRO ARTHROPLASTY GLENOHUMERAL JNT HEMI LT","code_information":[{"code":"9751309","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2986.0,"discounted_cash":1791.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23470 PRO ARTHROPLASTY GLENOHUMERAL JNT HEMI RT","code_information":[{"code":"9751310","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2986.0,"discounted_cash":1791.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26607 PRO CLSD TRMNT METACARPAL FX W/MANIP LT","code_information":[{"code":"9751311","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1837.0,"discounted_cash":1102.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26607 PRO CLSD TRMNT METACARPAL FX W/MANIP RT","code_information":[{"code":"9751312","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26607","type":"HCPCS"}],"standard_charges":[{"gross_charge":1837.0,"discounted_cash":1102.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25535 PRO CLSD TX ULNAR SHAFT FX W/MANIP RT","code_information":[{"code":"9751313","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1538.0,"discounted_cash":922.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25535 PRO CLSD TX ULNAR SHAFT FX W/MANIP LT","code_information":[{"code":"9751314","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1538.0,"discounted_cash":922.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29405 PRO APPLICATION SHORT LEG CAST KNEE/TOES RT","code_information":[{"code":"9751315","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29405 PRO APPLICATION SHORT LEG CAST KNEE/TOES LT","code_information":[{"code":"9751316","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.0,"discounted_cash":170.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29860 PRO ARTHROSCOPY HIP DIAGNOSTIC RT","code_information":[{"code":"9751317","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29860","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.0,"discounted_cash":1309.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29860 PRO ARTHROSCOPY HIP DIAGNOSTIC LT","code_information":[{"code":"9751318","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29860","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.0,"discounted_cash":1309.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27486 PRO REVISION TOTAL KNEE ARTHROPLASTY, W OR W/O ALLOGRAFT; 1 COMP - RT","code_information":[{"code":"9751319","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27486","type":"HCPCS"}],"standard_charges":[{"gross_charge":5254.0,"discounted_cash":3152.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27486 PRO REVISION TOTAL KNEE ARTHROPLASTY, W OR W/O ALLOGRAFT; 1 COMP - LT","code_information":[{"code":"9751320","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27486","type":"HCPCS"}],"standard_charges":[{"gross_charge":5254.0,"discounted_cash":3152.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26055 PRO TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER) - RT","code_information":[{"code":"9751321","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2262.0,"discounted_cash":1357.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26055 PRO TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER) - LT","code_information":[{"code":"9751322","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26055","type":"HCPCS"}],"standard_charges":[{"gross_charge":2262.0,"discounted_cash":1357.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28002 PRO I&D BELOW FASCIA, FOOT; SINGLE BURSAL SPACE - RT","code_information":[{"code":"9751323","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28002","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":586.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28002 PRO I&D BELOW FASCIA, FOOT; SINGLE BURSAL SPACE - LT","code_information":[{"code":"9751324","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28002","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.0,"discounted_cash":586.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28286 PRO CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE - RT","code_information":[{"code":"9751325","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":697.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28286 PRO CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE - LT","code_information":[{"code":"9751326","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":697.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28292 PRO CORRECT, HALLUX VALGUS, W SESAMOIDECTOMY; W RESECT PROX PHAL - RT","code_information":[{"code":"9751327","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28292","type":"HCPCS"}],"standard_charges":[{"gross_charge":2148.0,"discounted_cash":1288.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28292 PRO CORRECT, HALLUX VALGUS, W SESAMOIDECTOMY; W RESECT PROX PHAL - LT","code_information":[{"code":"9751328","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28292","type":"HCPCS"}],"standard_charges":[{"gross_charge":2148.0,"discounted_cash":1288.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25415 PRO REPAIR NONUNION OR MALUNION, RADIUS & ULNA; WO GRAFT - RT","code_information":[{"code":"9751329","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25415","type":"HCPCS"}],"standard_charges":[{"gross_charge":3160.0,"discounted_cash":1896.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25415 PRO REPAIR NONUNION OR MALUNION, RADIUS & ULNA; WO GRAFT - LT","code_information":[{"code":"9751330","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25415","type":"HCPCS"}],"standard_charges":[{"gross_charge":3160.0,"discounted_cash":1896.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24615 PRO OPEN TRMNT ELBOW DISLOCATION RT","code_information":[{"code":"9751331","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2765.0,"discounted_cash":1659.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24615 PRO OPEN TRMNT ELBOW DISLOCATION LT","code_information":[{"code":"9751332","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24615","type":"HCPCS"}],"standard_charges":[{"gross_charge":2765.0,"discounted_cash":1659.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27447 PRO TOTAL KNEE ARTHROPLASTY RT","code_information":[{"code":"9751333","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27447","type":"HCPCS"}],"standard_charges":[{"gross_charge":5243.0,"discounted_cash":3145.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27447 PRO TOTAL KNEE ARTHROPLASTY LT","code_information":[{"code":"9751334","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27447","type":"HCPCS"}],"standard_charges":[{"gross_charge":5243.0,"discounted_cash":3145.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27125 PRO HEMIARTHROPLASTY HIP PARTIAL RT","code_information":[{"code":"9751335","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27125","type":"HCPCS"}],"standard_charges":[{"gross_charge":4211.0,"discounted_cash":2526.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27125 PRO HEMIARTHROPLASTY HIP PARTIAL LT","code_information":[{"code":"9751336","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27125","type":"HCPCS"}],"standard_charges":[{"gross_charge":4211.0,"discounted_cash":2526.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24120 PRO EXCISION/CURETTAGE BONE CYST/BENIGN TUMOR ELBOW RT","code_information":[{"code":"9751337","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.0,"discounted_cash":1732.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24120 PRO EXCISION/CURETTAGE BONE CYST/BENIGN TUMOR ELBOW LT","code_information":[{"code":"9751338","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.0,"discounted_cash":1732.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25020 PRO DECOM FASCT, FORARM &/OR WRIST, FLXR OR EXT CMPRTMNT W/O DEBRID RT","code_information":[{"code":"9751339","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3083.0,"discounted_cash":1849.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25020 PRO DECOM FASCT, FORARM &/OR WRIST, FLXR OR EXT CMPRTMNT W/O DEBRID LT","code_information":[{"code":"9751340","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25020","type":"HCPCS"}],"standard_charges":[{"gross_charge":3083.0,"discounted_cash":1849.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64718 PRO NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW - RT","code_information":[{"code":"9751341","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2914.0,"discounted_cash":1748.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64718 PRO NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW - LT","code_information":[{"code":"9751342","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64718","type":"HCPCS"}],"standard_charges":[{"gross_charge":2914.0,"discounted_cash":1748.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27282 PRO ARTHRODESIS SYMPHYSIS PUBIS INC OBT GRAFT","code_information":[{"code":"9751343","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27282","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":1818.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29345 PRO APPLY LONG LEG CAST (THIGH TO TOES)  RT","code_information":[{"code":"9751344","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":264.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29345 PRO APPLY LONG LEG CAST (THIGH TO TOES)  LT","code_information":[{"code":"9751345","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":264.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29870 PRO ARTHROSCOPY KNEE DX W/WO SYNOVIAL BX RT","code_information":[{"code":"9751346","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1912.0,"discounted_cash":1147.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29870 PRO ARTHROSCOPY KNEE DX W/WO SYNOVIAL BX LT","code_information":[{"code":"9751347","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1912.0,"discounted_cash":1147.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27091 PRO RMVL HIP PROSTH COMP W/TOTAL HIP PROSTH MMA RT","code_information":[{"code":"9751348","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27091","type":"HCPCS"}],"standard_charges":[{"gross_charge":6533.0,"discounted_cash":3919.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27091 PRO RMVL HIP PROSTH COMP W/TOTAL HIP PROSTH MMA LT","code_information":[{"code":"9751349","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27091","type":"HCPCS"}],"standard_charges":[{"gross_charge":6533.0,"discounted_cash":3919.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27886 PRO AMPUTATION LEG THRU TIBIA/FIBIA, REAMPUTATION RT","code_information":[{"code":"9751350","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27886","type":"HCPCS"}],"standard_charges":[{"gross_charge":2625.0,"discounted_cash":1575.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27886 PRO AMPUTATION LEG THRU TIBIA/FIBIA, REAMPUTATION LT","code_information":[{"code":"9751351","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27886","type":"HCPCS"}],"standard_charges":[{"gross_charge":2625.0,"discounted_cash":1575.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28800 PRO AMPUTATION FT MIDTARSAL RT","code_information":[{"code":"9751354","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1091.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28800 PRO AMPUTATION FT MIDTARSAL LT","code_information":[{"code":"9751355","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.0,"discounted_cash":1091.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28805 PRO AMPUTATION, FOOT; TRANSMETATARSAL-RT","code_information":[{"code":"9751356","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2057.0,"discounted_cash":1234.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28805 PRO AMPUTATION, FOOT; TRANSMETATARSAL-LT","code_information":[{"code":"9751357","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28805","type":"HCPCS"}],"standard_charges":[{"gross_charge":2057.0,"discounted_cash":1234.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26992 PRO INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT-RT","code_information":[{"code":"9751358","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26992","type":"HCPCS"}],"standard_charges":[{"gross_charge":4029.0,"discounted_cash":2417.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26992 PRO INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT-LT","code_information":[{"code":"9751359","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26992","type":"HCPCS"}],"standard_charges":[{"gross_charge":4029.0,"discounted_cash":2417.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25360 PRO OSTEOTOMY ULNA RT","code_information":[{"code":"9751360","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25360","type":"HCPCS"}],"standard_charges":[{"gross_charge":2377.0,"discounted_cash":1426.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25360 PRO OSTEOTOMY ULNA LT","code_information":[{"code":"9751361","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25360","type":"HCPCS"}],"standard_charges":[{"gross_charge":2377.0,"discounted_cash":1426.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28288 PRO OSTECTOMY PARTIAL EXOSTC/CONDTL METATARSEL HEAD RT","code_information":[{"code":"9751362","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1176.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28288 PRO OSTECTOMY PARTIAL EXOSTC/CONDTL METATARSEL HEAD LT","code_information":[{"code":"9751363","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28288","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.0,"discounted_cash":1176.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25111 PRO REMOVE WRIST TENDON LESION RT","code_information":[{"code":"9751364","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25111","type":"HCPCS"}],"standard_charges":[{"gross_charge":2259.0,"discounted_cash":1355.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25111 PRO REMOVE WRIST TENDON LESION LT","code_information":[{"code":"9751365","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25111","type":"HCPCS"}],"standard_charges":[{"gross_charge":2259.0,"discounted_cash":1355.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28104 PRO EXCISION/CURETTAGE BONE CYST/BENIGN TUMOR, TARSAL/METATARSAL - RT","code_information":[{"code":"9751366","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28104","type":"HCPCS"}],"standard_charges":[{"gross_charge":3983.0,"discounted_cash":2389.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28104 PRO EXCISION/CURETTAGE BONE CYST/BENIGN TUMOR, TARSAL/METATARSAL - LT","code_information":[{"code":"9751367","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28104","type":"HCPCS"}],"standard_charges":[{"gross_charge":3983.0,"discounted_cash":2389.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28108 PRO EXCISION/CURETTAGE OF BONE CYST/BENIGN TUMOR, PHALANGES OF FOOT","code_information":[{"code":"9751368","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28108","type":"HCPCS"}],"standard_charges":[{"gross_charge":3983.0,"discounted_cash":2389.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28003 PRO INCISION & DRAINAGE BELOW FASCIA, FOOT; MULTIPLE AREAS - RT","code_information":[{"code":"9751369","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"discounted_cash":856.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28003 PRO INCISION & DRAINAGE BELOW FASCIA, FOOT; MULTIPLE AREAS - LT","code_information":[{"code":"9751370","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.0,"discounted_cash":856.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27632 PRO EXCISION, TUMOR, SOFT TISSUE OF LEG/ANKLE AREA, SUBQ; 3 CM/> - RT","code_information":[{"code":"9751371","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.0,"discounted_cash":807.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27632 PRO EXCISION, TUMOR, SOFT TISSUE OF LEG/ANKLE AREA, SUBQ; 3 CM/> - LT","code_information":[{"code":"9751372","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.0,"discounted_cash":807.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28119 PRO REMOVAL OF HEEL SPUR RT","code_information":[{"code":"9751373","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28119","type":"HCPCS"}],"standard_charges":[{"gross_charge":1984.0,"discounted_cash":1190.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28119 PRO REMOVAL OF HEEL SPUR LT","code_information":[{"code":"9751374","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28119","type":"HCPCS"}],"standard_charges":[{"gross_charge":1984.0,"discounted_cash":1190.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29895 PRO ARTHROSCOPY, ANKLE, SURGICAL; SYNOVECTOMY, PARTIAL-RT","code_information":[{"code":"9751375","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29895","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":974.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29895 PRO ARTHROSCOPY, ANKLE, SURGICAL; SYNOVECTOMY, PARTIAL-LT","code_information":[{"code":"9751376","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29895","type":"HCPCS"}],"standard_charges":[{"gross_charge":1624.0,"discounted_cash":974.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29899 PRO ARTHROSCOPY, ANKLE, SURGICAL; W/ANKLE ARTHRODESIS-RT","code_information":[{"code":"9751377","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29899","type":"HCPCS"}],"standard_charges":[{"gross_charge":3244.0,"discounted_cash":1946.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29899 PRO ARTHROSCOPY, ANKLE, SURGICAL; W/ANKLE ARTHRODESIS-LT","code_information":[{"code":"9751378","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29899","type":"HCPCS"}],"standard_charges":[{"gross_charge":3244.0,"discounted_cash":1946.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26370 PRO REPAIR PROFUNDUS TENDON, W/NTC SUPFCIS TENDON; PRIMARY, EA TENDON","code_information":[{"code":"9751379","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26370","type":"HCPCS"}],"standard_charges":[{"gross_charge":3990.0,"discounted_cash":2394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24577 PRO CLOSED TX HUMERAL CONDYLAR FX, MEDIAL OR LATERAL; W MANIP-RT","code_information":[{"code":"9751380","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24577 PRO CLOSED TX HUMERAL CONDYLAR FX, MEDIAL OR LATERAL; W MANIP-LT","code_information":[{"code":"9751381","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24577","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":126.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 20525 PRO REMOVAL FOREIGN BODY MUSCLE OR TENDON SHEATH, DEEP OR COMPLICATED","code_information":[{"code":"9751382","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20525","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.0,"discounted_cash":986.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27840 PRO CLSD ANKLE DISLOCATION, W/O ANES-RT","code_information":[{"code":"9751383","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2689.0,"discounted_cash":1613.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27840 PRO CLSD ANKLE DISLOCATION, W/O ANES-LT","code_information":[{"code":"9751384","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":2689.0,"discounted_cash":1613.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24435 PRO REPAIR HUMERUS W/ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAIN GRAFT)","code_information":[{"code":"9751385","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24435","type":"HCPCS"}],"standard_charges":[{"gross_charge":4473.0,"discounted_cash":2683.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 26160 PRO EXCISION TENDON SHEATH LESION OR JOINT CAPSULE, HAND OR FINGER","code_information":[{"code":"9751386","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2896.0,"discounted_cash":1737.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29876 PRO ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2/> COMPARTMENTS","code_information":[{"code":"9751387","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3847.0,"discounted_cash":2308.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27884 PRO AMPUTATION, LEG, THRU TIBIA & FIBULA; 2NDARY CLOSURE/SCAR REVISION","code_information":[{"code":"9751388","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27884","type":"HCPCS"}],"standard_charges":[{"gross_charge":1724.0,"discounted_cash":1034.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27487 PRO REVISE TOTAL KNEE ARTHROPLASTY; FEM & /OR TIBIAL COMPONENT","code_information":[{"code":"9751389","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27487","type":"HCPCS"}],"standard_charges":[{"gross_charge":7045.0,"discounted_cash":4227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29891 PRO ARTHROSCOPY, ANKLE, EXCISION OSTEOCHNDRL DEFECT, W DRILLING DEFECT","code_information":[{"code":"9751390","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29891","type":"HCPCS"}],"standard_charges":[{"gross_charge":2531.0,"discounted_cash":1518.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29863 PRO ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY","code_information":[{"code":"9751391","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29863","type":"HCPCS"}],"standard_charges":[{"gross_charge":4786.0,"discounted_cash":2871.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23655 PRO CLOSED TREATMENT SHOULDER DISLOCATION, W MANIPULATION; REQ ANESTHESIA","code_information":[{"code":"9751392","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":1407.0,"discounted_cash":844.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25000 PRO INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DE QUERVAINS DISEASE)","code_information":[{"code":"9751393","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2747.0,"discounted_cash":1648.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27726 PRO REPAIR FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION - RT","code_information":[{"code":"9751394","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27726","type":"HCPCS"}],"standard_charges":[{"gross_charge":4142.0,"discounted_cash":2485.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27726 PRO REPAIR FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION - LT","code_information":[{"code":"9751395","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27726","type":"HCPCS"}],"standard_charges":[{"gross_charge":4142.0,"discounted_cash":2485.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27248 PRO OPEN TREATMENT GREATER TROCHANTERIC FRACTURE, INCL INTERNAL FIX- RT","code_information":[{"code":"9751396","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2771.0,"discounted_cash":1662.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27248 PRO OPEN TREATMENT GREATER TROCHANTERIC FRACTURE, INCL INTERNAL FIX- LT","code_information":[{"code":"9751397","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27248","type":"HCPCS"}],"standard_charges":[{"gross_charge":2771.0,"discounted_cash":1662.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28153 PRO RESECTION, CONDYLE (S), DISTAL END OF PHALANX, EACH TOE","code_information":[{"code":"9751398","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28153","type":"HCPCS"}],"standard_charges":[{"gross_charge":1101.0,"discounted_cash":660.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29894 PRO ARTHROSCOPY, ANKLE, SURGICAL; W REMOVAL OF LOOSE OR FOREIGN BODY","code_information":[{"code":"9751399","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1595.0,"discounted_cash":957.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27386 PRO SUTURE QUADRICEPS/HAMSTRING MUSCLE RUPTURE; RCNSTR, INCL GRAFT","code_information":[{"code":"9751400","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27386","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.0,"discounted_cash":1818.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28635 PRO CLOSED TREAT METATARSOPHALANGEAL JOINT DISLOCATION; REQ ANESTHESIA","code_information":[{"code":"9751401","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":878.0,"discounted_cash":526.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29877 PRO ARTHROSCOPY, KNEE, SURGICAL; DEBRIDE/SHAVE ARTICULAR CARTILAGE-RT","code_information":[{"code":"9751402","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29877","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.0,"discounted_cash":1767.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29877 PRO ARTHROSCOPY, KNEE, SURGICAL; DEBRIDE/SHAVE ARTICULAR CARTILAGE-LT","code_information":[{"code":"9751403","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29877","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.0,"discounted_cash":1767.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28755 PRO ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT","code_information":[{"code":"9751404","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1775.0,"discounted_cash":1065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 12041 PRO REPAIR INTERMEDIATE NECK/HAND/FEET/XTRNL GENT 2.5CM/<","code_information":[{"code":"9751405","type":"CDM"},{"code":"0975","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.0,"discounted_cash":343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27244 PRO TX INTER/PERI/SUBTRCHNTRIC FEMORAL FX W PLATE/SCREW IMPLT W/WO CERC","code_information":[{"code":"9751406","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27244","type":"HCPCS"}],"standard_charges":[{"gross_charge":4417.0,"discounted_cash":2650.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27497 PRO DECOMPRESS FASCIOTOMY, THIGH &/KNEE W DEBRIDEMENT MUSCLE &/NERVE","code_information":[{"code":"9751407","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27497","type":"HCPCS"}],"standard_charges":[{"gross_charge":1957.0,"discounted_cash":1174.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27350 PRO PATELLECTOMY OR HEMIPATELLECTOMY","code_information":[{"code":"9751408","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27350","type":"HCPCS"}],"standard_charges":[{"gross_charge":2174.0,"discounted_cash":1304.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29884 PRO ARTHROSCOPY, KNEE; W/LYSIS ADHESIONS, W/WO MANIPUL (SEPARATE PROC)","code_information":[{"code":"9751409","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29884","type":"HCPCS"}],"standard_charges":[{"gross_charge":2951.0,"discounted_cash":1770.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27269 PRO OPEN TX FEMORAL FX, PROXIMAL END, HEAD, INC INTERNAL FIX, W PERFORM","code_information":[{"code":"9751410","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27269","type":"HCPCS"}],"standard_charges":[{"gross_charge":3784.0,"discounted_cash":2270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27664 PRO REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON","code_information":[{"code":"9751411","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27664","type":"HCPCS"}],"standard_charges":[{"gross_charge":1666.0,"discounted_cash":999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28315 PRO SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)","code_information":[{"code":"9751412","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.0,"discounted_cash":875.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24430 PRO REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT","code_information":[{"code":"9751413","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24430","type":"HCPCS"}],"standard_charges":[{"gross_charge":3705.0,"discounted_cash":2223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23700 PRO MANIPULATION W/ANESTHESIA, SHOULDER JOINT, WITH FIXATION APPARATUS","code_information":[{"code":"9751414","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1111.0,"discounted_cash":666.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25040 PRO ARTHROTOMY, RADIOCARPAL/MIDCARPAL JOINT, W/EXPL, DRG/RMVL OF FB","code_information":[{"code":"9751415","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25040","type":"HCPCS"}],"standard_charges":[{"gross_charge":2252.0,"discounted_cash":1351.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28200 PRO REPAIR, TDN, FLXR, FOOT; PRIMARY/SECOND, W/O FREE GRAFT, EA TENDON","code_information":[{"code":"9751416","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2036.0,"discounted_cash":1221.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28210 PRO RPR, TENDON, XTNSR, FOOT SEC W/FREE GRAFT, EA TNDN (INCL OBTN GRFT)","code_information":[{"code":"9751417","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1218.0,"discounted_cash":730.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 25350 PRO OSTEOTOMY, RADIUS; DISTAL THIRD","code_information":[{"code":"9751418","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1704.0,"discounted_cash":1022.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27704 PRO REMOVAL OF ANKLE IMPLANT","code_information":[{"code":"9751419","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27704","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.0,"discounted_cash":1106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28202 PRO RPR, TENDON, FLXR, FOOT; SEC W/FREE GRAFT, EA TENDON (INCL GRAFT)","code_information":[{"code":"9751420","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28202","type":"HCPCS"}],"standard_charges":[{"gross_charge":4623.0,"discounted_cash":2773.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27606 PRO TENOTOMY, PERCUT, ACHILLES TENDON (SEPARATE PROC); GENERAL ANES","code_information":[{"code":"9751421","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27606","type":"HCPCS"}],"standard_charges":[{"gross_charge":1086.0,"discounted_cash":651.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20611 PRO ARTHOCENTESIS, ASPIRATION/INJ, MAJOR JOINT/BURSA; W US, REC/REPORT","code_information":[{"code":"9751422","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11626 PRO EXCISION MALIGNANT LESION INC MARGIN, S/N/H/F/G; DIAM >4.0 CM","code_information":[{"code":"9751423","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11626","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28193 PRO REMOVAL FOREIGN BODY FOOT COMPLICATED","code_information":[{"code":"9751424","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28193","type":"HCPCS"}],"standard_charges":[{"gross_charge":1367.0,"discounted_cash":820.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 24346 PRO RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, W TENDON GRAFT","code_information":[{"code":"9751425","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24346","type":"HCPCS"}],"standard_charges":[{"gross_charge":2335.0,"discounted_cash":1401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64856 PRO SUTURE MAJOR PERIPHERAL NERVE, ARM/LEG, EXCEPT SCIATIC; INCL TRANSP","code_information":[{"code":"9751426","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64856","type":"HCPCS"}],"standard_charges":[{"gross_charge":3568.0,"discounted_cash":2140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27025 PRO FASCIOTOMY HIP OR THIGH ANY TYPE","code_information":[{"code":"9751427","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27025","type":"HCPCS"}],"standard_charges":[{"gross_charge":2679.0,"discounted_cash":1607.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27652 PRO REPAIR, PRIMARY, OPEN/PERCUTANEOUS, RUPTURED ACHILLES TENDON; W GRAFT","code_information":[{"code":"9751428","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27652","type":"HCPCS"}],"standard_charges":[{"gross_charge":1609.0,"discounted_cash":965.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27327 PRO EXCISION TUMOR SOFT TISSUE THIGH/KNEE AREA, SUBCUTANEOUS; < 3 CM","code_information":[{"code":"9751429","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27327","type":"HCPCS"}],"standard_charges":[{"gross_charge":2358.0,"discounted_cash":1414.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 29505 PRO APP LONG LEG SPLINT LT","code_information":[{"code":"9751430","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 29505 PRO APP LONG LEG SPLINT RT","code_information":[{"code":"9751431","type":"CDM"},{"code":"0975","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26591 PRO REPAIR MUCSLES OF HAND LT","code_information":[{"code":"9751432","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26591","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.0,"discounted_cash":757.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26591 PRO REPAIR MUCSLES OF HAND RT","code_information":[{"code":"9751433","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26591","type":"HCPCS"}],"standard_charges":[{"gross_charge":1262.0,"discounted_cash":757.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27165 PRO INCISION/FIXATION OF FEMUR LT","code_information":[{"code":"9751434","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27165","type":"HCPCS"}],"standard_charges":[{"gross_charge":4013.0,"discounted_cash":2407.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27165 PRO INCISION/FIXATION OF FEMUR RT","code_information":[{"code":"9751435","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27165","type":"HCPCS"}],"standard_charges":[{"gross_charge":4013.0,"discounted_cash":2407.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27767 PRO CLOSED TRTMNT POST ANKLE FX LT","code_information":[{"code":"9751436","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":492.6,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27767 PRO CLOSED TRTMNT POST ANKLE FX RT","code_information":[{"code":"9751437","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27767","type":"HCPCS"}],"standard_charges":[{"gross_charge":821.0,"discounted_cash":492.6,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28208 PRO REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON","code_information":[{"code":"9751438","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28208","type":"HCPCS"}],"standard_charges":[{"gross_charge":1644.0,"discounted_cash":986.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27360 PRO PARTIAL EXCISION BONE, FEMUR, PROXIMAL TIBIA AND/OR FIBULA","code_information":[{"code":"9751439","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27360","type":"HCPCS"}],"standard_charges":[{"gross_charge":2820.0,"discounted_cash":1692.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27818 PRO CLSD TX TRIMALLEOLAR ANKLE FX W/MANIP-BILAT","code_information":[{"code":"9751440","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1880.0,"discounted_cash":1128.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 27187 PRO PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR-RT","code_information":[{"code":"9751441","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27187","type":"HCPCS"}],"standard_charges":[{"gross_charge":3934.0,"discounted_cash":2360.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27187 PRO PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR-LT","code_information":[{"code":"9751442","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27187","type":"HCPCS"}],"standard_charges":[{"gross_charge":3934.0,"discounted_cash":2360.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64455 PRO INJ AGENT/STEROID PLNTR DIGIT NERVE","code_information":[{"code":"9751452","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64455","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 64895 PRO NERVE GRAFT MLT STRANDS HAND/FOOT, 4.0 CM OR LESS","code_information":[{"code":"9751456","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64895","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11045 PRO DEBRIDE SUBQ TISSUE EA ADD 20 SQ CM","code_information":[{"code":"9751462","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 97607 PRO NEGATIVE PRESSURE WOUND THERAPY </= 50 SQ CM","code_information":[{"code":"9751500","type":"CDM"},{"code":"0975","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11104 PRO PUNCH BX SKIN SINGLE LESION","code_information":[{"code":"9751801","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":125.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11105 PRO PUNCH BX SKIN EA SEPARATE ADD LESION","code_information":[{"code":"9751802","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11422 PRO EXC BENIGN LESION SCLP/NCK/HNDS/FT 1.1-2.0CM","code_information":[{"code":"9751813","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11422","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":131.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11423 PRO EXC BENIGN LESION SCLP/NCK/HNDS/FT 2.1-3.0CM","code_information":[{"code":"9751814","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11423","type":"HCPCS"}],"standard_charges":[{"gross_charge":575.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 11424 PRO EXC BENIGN LESION SCLP/NCK/HNDS/FT 3.1-4.0CM","code_information":[{"code":"9751815","type":"CDM"},{"code":"0975","type":"RC"},{"code":"11424","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 20702 PRO INSERT DRUG DELIVERY DEVICE IN BONE","code_information":[{"code":"9751898","type":"CDM"},{"code":"0975","type":"RC"},{"code":"20702","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":193.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 23630 PRO OPEN TXT HUMERUS FRACTURE LT","code_information":[{"code":"9751947","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23630","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.0,"discounted_cash":1397.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23630 PRO OPEN TXT HUMERUS FRACTURE RT","code_information":[{"code":"9751948","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23630","type":"HCPCS"}],"standard_charges":[{"gross_charge":2329.0,"discounted_cash":1397.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23680 PRO OPEN TXT SHOULDER DISCLOCATION W/FX NECK LT","code_information":[{"code":"9751956","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23680","type":"HCPCS"}],"standard_charges":[{"gross_charge":2032.0,"discounted_cash":1219.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23680 PRO OPEN TXT SHOULDER DISCLOCATION W/FX NECK RT","code_information":[{"code":"9751957","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23680","type":"HCPCS"}],"standard_charges":[{"gross_charge":2032.0,"discounted_cash":1219.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 23680 PRO OPEN TXT SHOULDER DISCLOCATION W/FX NECK BLT","code_information":[{"code":"9751958","type":"CDM"},{"code":"0975","type":"RC"},{"code":"23680","type":"HCPCS"}],"standard_charges":[{"gross_charge":3048.0,"discounted_cash":1828.8,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 24130 PRO EXC RADIAL HEAD LT","code_information":[{"code":"9751977","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":690.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24130 PRO EXC RADIAL HEAD RT","code_information":[{"code":"9751978","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.0,"discounted_cash":690.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 24130 PRO EXC RADIAL HEAD BLT","code_information":[{"code":"9751979","type":"CDM"},{"code":"0975","type":"RC"},{"code":"24130","type":"HCPCS"}],"standard_charges":[{"gross_charge":1724.0,"discounted_cash":1034.4,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 25310 PRO TRANSPLANT FOREARM/WRIST TENDON LT","code_information":[{"code":"9752034","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":838.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 25310 PRO TRANSPLANT FOREARM/WRIST TENDON RT","code_information":[{"code":"9752035","type":"CDM"},{"code":"0975","type":"RC"},{"code":"25310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1397.0,"discounted_cash":838.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26410 PRO REPAIR HAND TENDON W/O GRAFT LT","code_information":[{"code":"9752084","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1283.0,"discounted_cash":769.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26410 PRO REPAIR HAND TENDON W/O GRAFT RT","code_information":[{"code":"9752085","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26410","type":"HCPCS"}],"standard_charges":[{"gross_charge":1283.0,"discounted_cash":769.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26440 PRO RELEASE PALM/FINGER TENDON LT","code_information":[{"code":"9752088","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.0,"discounted_cash":859.8,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 26440 PRO RELEASE PALM/FINGER TENDON RT","code_information":[{"code":"9752089","type":"CDM"},{"code":"0975","type":"RC"},{"code":"26440","type":"HCPCS"}],"standard_charges":[{"gross_charge":1433.0,"discounted_cash":859.8,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27122 PRO ACETABULOPLASTY RESECTION FEMORAL HEAD LT","code_information":[{"code":"9752129","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27122","type":"HCPCS"}],"standard_charges":[{"gross_charge":2487.0,"discounted_cash":1492.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27122 PRO ACETABULOPLASTY RESECTION FEMORAL HEAD RT","code_information":[{"code":"9752130","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27122","type":"HCPCS"}],"standard_charges":[{"gross_charge":2487.0,"discounted_cash":1492.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27122 PRO ACETABULOPLASTY RESECTION FEMORAL HEAD BLT","code_information":[{"code":"9752131","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27122","type":"HCPCS"}],"standard_charges":[{"gross_charge":3730.0,"discounted_cash":2238.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 27140 PRO OSTEOTOMY & TRANSFER GRTR TROCHANTER OF FEMUR SEP PROC LT","code_information":[{"code":"9752144","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1292.4,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27140 PRO OSTEOTOMY & TRANSFER GRTR TROCHANTER OF FEMUR SEP PROC RT","code_information":[{"code":"9752145","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27140","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.0,"discounted_cash":1292.4,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27140 PRO OSTEOTOMY & TRANSFER GRTR TROCHANTER OF FEMUR SEP PROC BLT","code_information":[{"code":"9752146","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3231.0,"discounted_cash":1938.6,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 27340 PRO EXC PREPATELLAR BURSA LT","code_information":[{"code":"9752168","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27340 PRO EXC PREPATELLAR BURSA RT","code_information":[{"code":"9752169","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27340","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 64897 PRO NERVE GRAFT MLT STRANDS ARM/LEG, 4.0 CM OR LESS","code_information":[{"code":"9752389","type":"CDM"},{"code":"0975","type":"RC"},{"code":"64897","type":"HCPCS"}],"standard_charges":[{"gross_charge":2686.0,"discounted_cash":1611.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28008 PRO FASCIOTOMY FOOT AND/OR TOE","code_information":[{"code":"9752424","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28008","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27702 PRO ARTHROPLASTY ANKLE W/ IMPLANT","code_information":[{"code":"9752446","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2305.0,"discounted_cash":1383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 22853 PRO INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD","code_information":[{"code":"9752449","type":"CDM"},{"code":"0975","type":"RC"},{"code":"22853","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":395.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 28080 PRO EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH - LT","code_information":[{"code":"9752482","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28080","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":547.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 28080 PRO EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH - RT","code_information":[{"code":"9752483","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28080","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.0,"discounted_cash":547.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC PRO 28092 EXCISION LESION, TENDON, SHEATH/CAPSULE W/SYNOVECTOMY; TOE(S), EACH","code_information":[{"code":"9752500","type":"CDM"},{"code":"0975","type":"RC"},{"code":"28092","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC"}]},{"description":"HC 27267 PRO CLSD TREAT FEMORAL FRACT, PROXIMAL END, HEAD; W/O MANIP - LT","code_information":[{"code":"9752502","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":562.2,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27267 PRO CLSD TREAT FEMORAL FRACT, PROXIMAL END, HEAD; W/O MANIP - RT","code_information":[{"code":"9752503","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":562.2,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27267 PRO CLSD TREAT FEMORAL FRACT, PROXIMAL END, HEAD; W/O MANIP - BLT","code_information":[{"code":"9752504","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27267","type":"HCPCS"}],"standard_charges":[{"gross_charge":1405.0,"discounted_cash":843.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 27566 PRO OPEN TREAT PATELLAR DISLOCAT W OR WO PARTL OR TTL PATELLECTOMY-LT","code_information":[{"code":"9752538","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27566","type":"HCPCS"}],"standard_charges":[{"gross_charge":2010.0,"discounted_cash":1206.0,"setting":"both","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27566 PRO OPEN TREAT PATELLAR DISLOCAT W OR WO PARTL OR TTL PATELLECTOMY-RT","code_information":[{"code":"9752539","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27566","type":"HCPCS"}],"standard_charges":[{"gross_charge":2010.0,"discounted_cash":1206.0,"setting":"both","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | 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":"HC 27566 PRO OPEN TREAT PATELLAR DISLOCAT W OR WO PARTL OR TTL PATELLECTOMY-BLT","code_information":[{"code":"9752540","type":"CDM"},{"code":"0975","type":"RC"},{"code":"27566","type":"HCPCS"}],"standard_charges":[{"gross_charge":3015.0,"discounted_cash":1809.0,"setting":"both","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 95816 PRO EEG, AWAKE AND DROWSY","code_information":[{"code":"9860006","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":405.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 95819 PRO EEG, AWAKE AND ASLEEP","code_information":[{"code":"9860007","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":633.0,"discounted_cash":379.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 95822 PRO EEG, SLEEP ONLY","code_information":[{"code":"9860008","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":462.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC EEG, CEREBRAL DEATH EVAL ONLY","code_information":[{"code":"9860009","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95824","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":314.4,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC ELECTROCORTICOGRAM AT SURGERY","code_information":[{"code":"9860010","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95829","type":"HCPCS"}],"standard_charges":[{"gross_charge":1102.0,"discounted_cash":661.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 95930 VISUAL EVOKED POTENT,CHCKRBRD/FLASH EXC GLAUCOMA W/INTERP","code_information":[{"code":"9860017","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95930","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":171.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 95803 ACTIGRAPHY TEST W/ RECRD,ANALY,INTERP, REPORT MINI 72HRS","code_information":[{"code":"9860027","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95803","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":570.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC 95938 PRO EVOKED POTENT STUDY UPPER & LOWER LIMBS","code_information":[{"code":"9860030","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95938","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.0,"discounted_cash":574.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC MOTOR EVOKED STUDY UPPER & LOWER LIMBS","code_information":[{"code":"9860031","type":"CDM"},{"code":"0986","type":"RC"},{"code":"95939","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.0,"discounted_cash":592.2,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC NDL EMG, EA EXTREM DONE W/NERVE COND;LTD","code_information":[{"code":"9860032","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95885","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC NDL EMG, EA EXTREM DONE W/NERVE COND;COMPLETE","code_information":[{"code":"9860033","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95886","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"HC NDL EMG, NON-EXT MUSC DONE W/NERVE CONDUCTION","code_information":[{"code":"9860034","type":"CDM"},{"code":"0960","type":"RC"},{"code":"95887","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"both","modifier_code":["26"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SAMC | The modified price is presented in the standard charge value. | Modifier 26: Professional Component"}]},{"description":"Srs cran les simple addl","code_information":[{"code":"61797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":256.22,"maximum":5538.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":256.22},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5538.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Srs cranial lesion simple","code_information":[{"code":"61796","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1160.75,"maximum":17033.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1160.75},{"payer_name":"Humana","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5538.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0}]}]},{"description":"Egd vol adjmt bariatric balo","code_information":[{"code":"0813T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":4932.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":981.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":991.38,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3401.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1020.54,"additional_payer_notes":"APC"}]}]},{"description":"Opn insj/rplcmt ins ptn subf","code_information":[{"code":"0817T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72763.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20997.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21205.31,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20789.52,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72763.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21829.0,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq","code_information":[{"code":"0818T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3746.49,"maximum":13112.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3783.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3746.49,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13112.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.82,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subf","code_information":[{"code":"0819T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3746.49,"maximum":13112.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3783.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3746.49,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13112.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.82,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 1chmbr ldls pm ra","code_information":[{"code":"0823T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":83428.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24075.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24313.36,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23836.63,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83428.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25028.46,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 1chmbr ldls pm ra","code_information":[{"code":"0824T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3383.62,"maximum":11842.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3417.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3451.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11842.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.8,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl1chmb ldls pm ra","code_information":[{"code":"0825T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72244.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20641.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72244.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21673.25,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl pg wcs lv both compnt","code_information":[{"code":"0861T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv battery only","code_information":[{"code":"0862T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":7738.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2233.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2255.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7738.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2321.6,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pg wcs lv trnsmtr only","code_information":[{"code":"0863T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":7738.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2233.16,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2255.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7738.67,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2321.6,"additional_payer_notes":"APC"}]}]},{"description":"Tpla b9 prst8 hyprplsa>=50ml","code_information":[{"code":"0867T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5745.80,"maximum":20110.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5860.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.8,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20110.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.09,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl hw fixj aug","code_information":[{"code":"0869T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":12272.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3541.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3576.46,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12272.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.65,"additional_payer_notes":"APC"}]}]},{"description":"Imp subq prtl ascts pmp sys","code_information":[{"code":"0870T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":128492.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37079.14,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37446.26,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36712.02,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128492.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38547.63,"additional_payer_notes":"APC"}]}]},{"description":"Rplcmt subq prtl ascites pmp","code_information":[{"code":"0871T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":100958.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29133.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29422.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28845.27,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100958.46,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30287.54,"additional_payer_notes":"APC"}]}]},{"description":"Rplcmt ndwllg bldr&prtl cath","code_information":[{"code":"0872T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3836.82,"maximum":13428.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3875.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3913.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3836.82,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13428.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4028.66,"additional_payer_notes":"APC"}]}]},{"description":"Revj subq prtl asct pmp sys","code_information":[{"code":"0873T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3836.82,"maximum":13428.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3875.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3913.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3836.82,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13428.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4028.66,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl pertl ascites pmp sys","code_information":[{"code":"0874T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3836.82,"maximum":13428.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3875.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3913.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3836.82,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13428.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4028.66,"additional_payer_notes":"APC"}]}]},{"description":"Intraop ther estim pn ue 1st","code_information":[{"code":"0882T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intraop ther estim pn ue ea","code_information":[{"code":"0883T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Subrta njx rx agt w/vtrc","code_information":[{"code":"0810T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4458.35,"maximum":15604.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4502.93,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4547.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7486.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4458.35,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15604.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12241.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4681.27,"additional_payer_notes":"APC"}]}]},{"description":"Tcat s&ivc prstc vl impl opn","code_information":[{"code":"0806T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Tcat s&ivc prstc vl impl prq","code_information":[{"code":"0805T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Tcat rmv&rpl2chmb ldls pm rv","code_information":[{"code":"0803T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72244.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20641.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72244.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21673.25,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl2chmb ldls pm ra","code_information":[{"code":"0802T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72244.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20641.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72244.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21673.25,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv&rpl 2chmbr ldls pm","code_information":[{"code":"0801T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72244.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20641.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72244.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21673.25,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm rv","code_information":[{"code":"0800T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3383.62,"maximum":11842.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3417.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3451.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11842.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.8,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm ra","code_information":[{"code":"0799T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3383.62,"maximum":11842.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3417.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3451.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11842.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.8,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 2chmbr ldls pm cmpl","code_information":[{"code":"0798T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3383.62,"maximum":11842.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3417.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3451.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11842.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.8,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm rv","code_information":[{"code":"0797T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72244.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20641.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72244.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21673.25,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm ra","code_information":[{"code":"0796T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":83428.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24075.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24313.36,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23836.63,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83428.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25028.46,"additional_payer_notes":"APC"}]}]},{"description":"Tcat ins 2chmbr ldls pm cmpl","code_information":[{"code":"0795T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72244.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20641.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72244.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21673.25,"additional_payer_notes":"APC"}]}]},{"description":"Pt spec alg rx-onc tx option","code_information":[{"code":"0794T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1468.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.48,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.38,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat thrm ablt nrv p-art","code_information":[{"code":"0793T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":68755.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19840.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20037.41,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19644.52,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68755.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.75,"additional_payer_notes":"APC"}]}]},{"description":"Revj rplcmt/rmvl vrt tethrg","code_information":[{"code":"0790T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":65763.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18977.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19165.36,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.56,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65763.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19729.04,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea sac w/nstim","code_information":[{"code":"0787T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3746.49,"maximum":13112.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3783.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3746.49,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13112.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.82,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt prq ra sac nstim","code_information":[{"code":"0786T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":41792.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12060.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12179.53,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11940.72,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41792.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12537.76,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea spi w/nstim","code_information":[{"code":"0785T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3746.49,"maximum":13112.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3783.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3746.49,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13112.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.82,"additional_payer_notes":"APC"}]}]},{"description":"Ins/rplmt eltrd ra spi nstim","code_information":[{"code":"0784T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":41792.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12060.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12179.53,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11940.72,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41792.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12537.76,"additional_payer_notes":"APC"}]}]},{"description":"Brnchsc rf dstrj plm nrv uni","code_information":[{"code":"0782T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Brnchsc rf dstrj pulm nrv bi","code_information":[{"code":"0781T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Instlj fecal microbiota ssp","code_information":[{"code":"0780T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1468.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":499.02,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":149.71,"additional_payer_notes":"APC"}]}]},{"description":"Njx stm cl prdct anl sft tis","code_information":[{"code":"0748T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Car ablt rad arrhyt dlvr rad","code_information":[{"code":"0747T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Car ablt rad arr cnv loc map","code_information":[{"code":"0746T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Car ablt rad arr n-invas loc","code_information":[{"code":"0745T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Insj bioprostc vlv fem vn","code_information":[{"code":"0744T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5963.01,"maximum":20870.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6082.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5963.01,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20870.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.16,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal prst8 mag fld ndct","code_information":[{"code":"0739T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Xenograft impltj artclr surf","code_information":[{"code":"0737T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":48153.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13895.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.33,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13758.17,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48153.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.08,"additional_payer_notes":"APC"}]}]},{"description":"Colonic lavage 35+l water","code_information":[{"code":"0736T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1468.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":139.27,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":140.65,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":482.61,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144.78,"additional_payer_notes":"APC"}]}]},{"description":"Prep tum cav iort prim crnot","code_information":[{"code":"0735T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Immntx admn electroporatn im","code_information":[{"code":"0732T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Trabeculotomy lsr w/oct gdn","code_information":[{"code":"0730T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Rmvl&rplcmt implt vstblr dev","code_information":[{"code":"0727T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Rmvl implt vstibular dev uni","code_information":[{"code":"0726T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Vestibular dev impltj uni","code_information":[{"code":"0725T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Prq elc nrv stim cn wo implt","code_information":[{"code":"0720T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":4932.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Pst vrt jt rplcmt lmbr 1 sgm","code_information":[{"code":"0719T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Adrc ther prtl rc tear njx","code_information":[{"code":"0718T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3797.52,"maximum":13291.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3835.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.47,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3797.52,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13291.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3987.4,"additional_payer_notes":"APC"}]}]},{"description":"Adrc ther prtl rc tear","code_information":[{"code":"0717T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3797.52,"maximum":13291.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3835.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3873.47,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3797.52,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13291.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3987.4,"additional_payer_notes":"APC"}]}]},{"description":"Car acous wavfrm rec cad rsk","code_information":[{"code":"0716T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1468.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.48,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.38,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl lsr ablt b9 prst8 hypr","code_information":[{"code":"0714T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":20110.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5860.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.8,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20110.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.09,"additional_payer_notes":"APC"}]}]},{"description":"Id ca immntx each addl njx","code_information":[{"code":"0709T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Id ca immntx prep & 1st njx","code_information":[{"code":"0708T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Njx b1 sub mtrl sbchdrl dfct","code_information":[{"code":"0707T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":12272.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3541.4,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3576.46,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12272.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3681.65,"additional_payer_notes":"APC"}]}]},{"description":"Njx pst chmbr eye medication","code_information":[{"code":"0699T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":8655.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2497.84,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2522.57,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8655.87,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2596.76,"additional_payer_notes":"APC"}]}]},{"description":"Removal pulse gen only isdss","code_information":[{"code":"0682T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3746.49,"maximum":13112.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3783.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3746.49,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13112.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.82,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pulse gen only isdss","code_information":[{"code":"0681T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3746.49,"maximum":13112.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3783.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3746.49,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13112.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.82,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt pg only isdss","code_information":[{"code":"0680T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":72763.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20997.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21205.31,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20789.52,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72763.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21829.0,"additional_payer_notes":"APC"}]}]},{"description":"Laps rmvl lead isdss","code_information":[{"code":"0679T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":39868.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11618.95,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.13,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39868.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11960.68,"additional_payer_notes":"APC"}]}]},{"description":"Laps repos lead isdss ea add","code_information":[{"code":"0678T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laps repos lead isdss 1st ld","code_information":[{"code":"0677T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":39868.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11618.95,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.13,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39868.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11960.68,"additional_payer_notes":"APC"}]}]},{"description":"Laps insj nw/rpcmt isdss ea","code_information":[{"code":"0676T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laps insj nw/rpcmt isdss 1ld","code_information":[{"code":"0675T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":41792.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12060.13,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12179.53,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11940.72,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41792.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12537.76,"additional_payer_notes":"APC"}]}]},{"description":"Laps insj nw/rpcmt prm isdss","code_information":[{"code":"0674T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":115736.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33398.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33729.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33067.68,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115736.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34721.07,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 thyr ndul perq lasr","code_information":[{"code":"0673T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":6194.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1787.58,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1805.28,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6194.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1858.38,"additional_payer_notes":"APC"}]}]},{"description":"Ndovag cryg rf remdl tiss","code_information":[{"code":"0672T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Insj ant sgm aq drg dev 1+","code_information":[{"code":"0671T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":19958.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5759.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5816.46,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5702.41,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19958.43,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5987.53,"additional_payer_notes":"APC"}]}]},{"description":"Bkbench rcnstj don uter artl","code_information":[{"code":"0670T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Bkbench rcnstj don uter ven","code_information":[{"code":"0669T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Bkbench prep don uter algrft","code_information":[{"code":"0668T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Don hysterectomy rcp uter","code_information":[{"code":"0667T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Don hysterectomy laps liv","code_information":[{"code":"0666T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Don hysterectomy open liv","code_information":[{"code":"0665T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Don hysterectomy open cdvr","code_information":[{"code":"0664T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Rmvl&Rimpltj ant sgm implt","code_information":[{"code":"0661T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4429.45,"maximum":15503.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4473.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4518.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4429.45,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15503.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4650.92,"additional_payer_notes":"APC"}]}]},{"description":"Implt ant sgm io nbio rx sys","code_information":[{"code":"0660T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4429.45,"maximum":15503.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4473.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4518.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4429.45,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15503.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4650.92,"additional_payer_notes":"APC"}]}]},{"description":"Tcat intra-c nfs supersat o2","code_information":[{"code":"0659T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Vrt bdy tethering ant 8+ seg","code_information":[{"code":"0657T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":65763.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18977.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19165.36,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.56,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65763.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19729.04,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant","code_information":[{"code":"0656T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":65763.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18977.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19165.36,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18789.56,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65763.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19729.04,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl focal abltj mal prst8","code_information":[{"code":"0655T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":20110.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5860.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.8,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20110.3,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.09,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal tube/cath","code_information":[{"code":"0654T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4131.60,"maximum":14460.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4172.91,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4214.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4131.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14460.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4338.18,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal bx 1/ml","code_information":[{"code":"0653T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":7197.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2076.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2097.46,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7197.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2159.15,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal dx br/wa","code_information":[{"code":"0652T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":7197.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2076.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2097.46,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7197.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2159.15,"additional_payer_notes":"APC"}]}]},{"description":"Mag ctrld capsule endoscopy","code_information":[{"code":"0651T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":4932.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":981.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":991.38,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3401.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1020.54,"additional_payer_notes":"APC"}]}]},{"description":"Insj gtube perq mag gastrpxy","code_information":[{"code":"0647T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":7197.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2076.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2097.46,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7197.18,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2159.15,"additional_payer_notes":"APC"}]}]},{"description":"Ttvi/rplcmt w/prstc vlv perq","code_information":[{"code":"0646T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Tcat impltj c sins rdctj dev","code_information":[{"code":"0645T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":68755.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19840.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20037.41,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19644.52,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68755.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.75,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl/dblk icar mas perq","code_information":[{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6099.19,"maximum":21347.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6160.18,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6221.17,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21347.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6404.14,"additional_payer_notes":"APC"}]}]},{"description":"Tcat l ventr rstrj dev implt","code_information":[{"code":"0643T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Perq tcat us abltj nrv p-art","code_information":[{"code":"0632T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":68755.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19840.97,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20037.41,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19644.52,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68755.83,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.75,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc ct lmbr ea","code_information":[{"code":"0630T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq njx algc ct lmbr 1st","code_information":[{"code":"0629T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7391.0,"maximum":48153.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13895.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.33,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13758.17,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48153.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.08,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc fluor lmbr ea","code_information":[{"code":"0628T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq njx algc fluor lmbr 1st","code_information":[{"code":"0627T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7391.0,"maximum":48153.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13895.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.33,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13758.17,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48153.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.08,"additional_payer_notes":"APC"}]}]},{"description":"Trabeculostomy int lsr w/scp","code_information":[{"code":"0622T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Trabeculostomy interno laser","code_information":[{"code":"0621T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4429.45,"maximum":15503.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4473.75,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4518.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4429.45,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15503.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4650.92,"additional_payer_notes":"APC"}]}]},{"description":"Evasc ven artlz tibl/prnl vn","code_information":[{"code":"0620T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":165203.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47673.03,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48145.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47201.02,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":165203.59,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49561.08,"additional_payer_notes":"APC"}]}]},{"description":"Cysto w/prst8 commissurotomy","code_information":[{"code":"0619T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Rmvl&rplcmt ss impl dfb pg","code_information":[{"code":"0614T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11772.0,"maximum":83428.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24075.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24313.36,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11772.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23836.63,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83428.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30023.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25028.46,"additional_payer_notes":"APC"}]}]},{"description":"Perq tcat intratrl septl sht","code_information":[{"code":"0613T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Ire abltj 1+tumors open","code_information":[{"code":"0601T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7391.0,"maximum":39868.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11618.95,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.13,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39868.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11960.68,"additional_payer_notes":"APC"}]}]},{"description":"Ire abltj 1+tum organ perq","code_information":[{"code":"0600T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7391.0,"maximum":39868.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11505.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11618.95,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.13,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39868.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11960.68,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu valve-pmp rplcmt","code_information":[{"code":"0597T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":2933.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":754.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2933.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2615.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.6,"additional_payer_notes":"APC"}]}]},{"description":"Temp fml iu vlv-pmp 1st insj","code_information":[{"code":"0596T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":2933.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":754.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":762.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2933.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2615.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":784.6,"additional_payer_notes":"APC"}]}]},{"description":"Osteot hum xtrnl lngth dev","code_information":[{"code":"0594T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7391.0,"maximum":27215.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7931.41,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7391.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27215.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17033.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8164.69,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal isdns ptn","code_information":[{"code":"0588T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3746.49,"maximum":13112.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3783.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3821.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3746.49,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13112.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.82,"additional_payer_notes":"APC"}]}]},{"description":"Perq impltj/rplcmt isdns ptn","code_information":[{"code":"0587T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":23902.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6897.71,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2933.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.42,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23902.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7170.89,"additional_payer_notes":"APC"}]}]},{"description":"Open islet cell transplant","code_information":[{"code":"0586T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laps islet cell transplant","code_information":[{"code":"0585T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Perq islet cell transplant","code_information":[{"code":"0584T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Tmpst auto tube dlvr sys","code_information":[{"code":"0583T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5819.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1679.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1695.96,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4932.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5819.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1745.84,"additional_payer_notes":"APC"}]}]},{"description":"Trurl abltj mal prst8 tiss","code_information":[{"code":"0582T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":49484.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14279.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14421.12,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.35,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49484.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14845.27,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal brst tum perq crtx","code_information":[{"code":"0581T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":14685.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4237.81,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4279.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14685.48,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4405.64,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl ss impl dfb pg only","code_information":[{"code":"0580T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Repos prev ss impl dfb eltrd","code_information":[{"code":"0574T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal ss dfb electrode","code_information":[{"code":"0573T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Insertion ss dfb electrode","code_information":[{"code":"0572T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8868.06,"maximum":31038.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8956.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.06,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31038.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9311.46,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt icds ss eltrd","code_information":[{"code":"0571T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11772.0,"maximum":117729.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33973.26,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34309.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11772.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33636.89,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117729.12,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30023.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35318.74,"additional_payer_notes":"APC"}]}]},{"description":"Ttvr perq ea addl prosth","code_information":[{"code":"0570T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Ttvr perq appr 1st prosth","code_information":[{"code":"0569T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Autol cell implt adps njx","code_information":[{"code":"0566T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Autol cell implt adps hrvg","code_information":[{"code":"0565T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Evac meibomian glnd heat bi","code_information":[{"code":"0563T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1468.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64.48,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":221.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66.38,"additional_payer_notes":"APC"}]}]},{"description":"Tcat tv annulus rcnstj","code_information":[{"code":"0545T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Tcat mv annulus rcnstj","code_information":[{"code":"0544T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Ta mv rpr w/artif chord tend","code_information":[{"code":"0543T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":5543.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5243.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal iims implt mntr only","code_information":[{"code":"0532T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal iims electrode only","code_information":[{"code":"0531T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal complete iims","code_information":[{"code":"0530T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims implt mntr","code_information":[{"code":"0527T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8868.06,"maximum":31038.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8956.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.06,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31038.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9311.46,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt iims eltrd only","code_information":[{"code":"0526T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8868.06,"maximum":31038.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8956.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9045.42,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.06,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31038.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9311.46,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt compl iims","code_information":[{"code":"0525T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":72244.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20847.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.01,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20641.19,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72244.16,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21673.25,"additional_payer_notes":"APC"}]}]},{"description":"Ev cath dir chem abltj w/img","code_information":[{"code":"0524T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3383.62,"maximum":11842.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3417.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3451.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11842.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.8,"additional_payer_notes":"APC"}]}]},{"description":"Ntrapx c ffr w/3d funcjl map","code_information":[{"code":"0523T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl&rplcmt pg wcs new eltrd","code_information":[{"code":"0520T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11200.55,"maximum":39201.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11424.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11772.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11200.55,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39201.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30023.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.58,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl & rplcmt pg compnt wcs","code_information":[{"code":"0519T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6168.0,"maximum":39201.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11424.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11200.55,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39201.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.58,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl pg compnt wcs","code_information":[{"code":"0518T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4004.60,"maximum":14016.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4044.64,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4084.69,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6168.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4004.6,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.08,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6223.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4204.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv pg compnt","code_information":[{"code":"0517T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":39201.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11424.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11200.55,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39201.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.58,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv eltrd only","code_information":[{"code":"0516T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9598.0,"maximum":39201.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11312.56,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11424.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9598.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11200.55,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39201.93,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21651.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11760.58,"additional_payer_notes":"APC"}]}]},{"description":"Insj wcs lv compl sys","code_information":[{"code":"0515T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11772.0,"maximum":83428.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24075.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24313.36,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11772.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23836.63,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83428.21,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30023.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25028.46,"additional_payer_notes":"APC"}]}]},{"description":"Esw integ wnd hlg ea addl","code_information":[{"code":"0513T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1468.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Esw integ wnd hlg 1st wnd","code_information":[{"code":"0512T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1468.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":217.15,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":219.3,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1468.0},{"payer_name":"Health Alliance Plan","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"The Alliance","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":752.51,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0},{"payer_name":"Zing","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":225.75,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rinsj sinus tarsi implt","code_information":[{"code":"0511T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5243.0,"maximum":27215.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7853.65,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee sche