{"hospital_name":"OSF St Mary Medical Center","last_updated_on":"2026-03-31","version":"3.0.0","location_name":["OSF St Mary Medical Center"],"hospital_address":["3333 North Seminary, Galesburg, IL 61401"],"license_information":{"license_number":"0002675","state":"IL"},"type_2_npi":["1164485363"],"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":"INSULIN LISPRO SUB-Q DOSE CALCULATOR SCHEDULED ORDERABLE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-7510-01","type":"NDC"}],"standard_charges":[{"gross_charge":294.05,"discounted_cash":176.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.22,"discounted_cash":3.73,"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":82.6,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6149-01","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":"AMIKACIN SULFATE 500 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6167-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.36,"discounted_cash":12.82,"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":"0641-6173-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.45,"discounted_cash":86.07,"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":"0250","type":"RC"},{"code":"0641-6175-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.35,"discounted_cash":15.21,"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":108.57,"discounted_cash":65.14,"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":"0641-6182-25","type":"NDC"}],"standard_charges":[{"gross_charge":106.1,"discounted_cash":63.66,"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":135.25,"discounted_cash":81.15,"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":0.99,"discounted_cash":0.59,"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":"0641-6207-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.32,"discounted_cash":47.59,"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":31.6,"discounted_cash":18.96,"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":55.38,"discounted_cash":33.23,"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":56.9,"discounted_cash":34.14,"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":47.84,"discounted_cash":28.70,"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":90.07,"discounted_cash":54.04,"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":12.59,"discounted_cash":7.55,"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":"0250","type":"RC"},{"code":"0781-3238-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.37,"discounted_cash":20.62,"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":"0781-3246-02","type":"NDC"}],"standard_charges":[{"gross_charge":27.88,"discounted_cash":16.72,"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":32.06,"discounted_cash":19.24,"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":67.26,"discounted_cash":40.36,"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":"0781-3422-92","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":"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":85.90,"discounted_cash":51.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6061-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.88,"discounted_cash":23.92,"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":"0517-7604-01","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":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-7604-25","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":"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":86.97,"discounted_cash":52.18,"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":480.75,"discounted_cash":288.45,"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":"0641-0367-21","type":"NDC"}],"standard_charges":[{"gross_charge":15.18,"discounted_cash":9.11,"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":11.15,"discounted_cash":6.69,"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":80.69,"discounted_cash":48.41,"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":80.75,"discounted_cash":48.45,"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":"0641-0476-21","type":"NDC"}],"standard_charges":[{"gross_charge":165.55,"discounted_cash":99.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-0928-21","type":"NDC"}],"standard_charges":[{"gross_charge":81.35,"discounted_cash":48.81,"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":89.07,"discounted_cash":53.44,"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":"0641-6008-01","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":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6020-01","type":"NDC"}],"standard_charges":[{"gross_charge":187.45,"discounted_cash":112.47,"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":83.43,"discounted_cash":50.06,"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":79.90,"discounted_cash":47.94,"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":87.5,"discounted_cash":52.5,"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":"0641-6057-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.12,"discounted_cash":25.27,"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":40.65,"discounted_cash":24.39,"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":31.0,"discounted_cash":18.6,"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":85.84,"discounted_cash":51.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 10 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-7504-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.88,"discounted_cash":20.33,"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":"0781-3440-71","type":"NDC"}],"standard_charges":[{"gross_charge":381.05,"discounted_cash":228.63,"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":0.79,"discounted_cash":0.47,"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":7.85,"discounted_cash":4.71,"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":7.85,"discounted_cash":4.71,"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":"25021-301-67","type":"NDC"}],"standard_charges":[{"gross_charge":18.59,"discounted_cash":11.15,"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":"25021-311-10","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":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-315-01","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":"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":16.6,"discounted_cash":9.96,"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":31.98,"discounted_cash":19.19,"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":15.70,"discounted_cash":9.42,"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":87.85,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML 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":4.53,"discounted_cash":2.72,"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":1.89,"discounted_cash":1.13,"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":80.69,"discounted_cash":48.41,"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":90.11,"discounted_cash":54.07,"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":"36000-012-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":12.19,"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":8.11,"discounted_cash":4.87,"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":1.14,"discounted_cash":0.68,"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":26.61,"discounted_cash":15.97,"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":13.34,"discounted_cash":8.01,"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":8.06,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":80.65,"discounted_cash":48.39,"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":99.3,"discounted_cash":59.58,"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":"0904-6623-61","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":"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":178.65,"discounted_cash":107.19,"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":"25021-132-83","type":"NDC"}],"standard_charges":[{"gross_charge":62.22,"discounted_cash":37.33,"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":"0904-7097-61","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":"PREDNISONE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7127-61","type":"NDC"}],"standard_charges":[{"gross_charge":0.26,"discounted_cash":0.15,"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":"0904-7141-10","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":"PROMETHAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7304-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":2.32,"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":"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":406.95,"discounted_cash":244.17,"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":33.7,"discounted_cash":20.22,"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":"0955-1004-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":16.31,"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":833.75,"discounted_cash":500.25,"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":1.93,"discounted_cash":1.16,"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":1.93,"discounted_cash":1.16,"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":148.55,"discounted_cash":89.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIKACIN SULFATE 500 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-290-41","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":"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":95.34,"discounted_cash":57.21,"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":179.86,"discounted_cash":107.91,"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":"23155-345-32","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":1.24,"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":"23155-547-31","type":"NDC"}],"standard_charges":[{"gross_charge":19.91,"discounted_cash":11.95,"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":19.84,"discounted_cash":11.90,"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":"25021-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.66,"discounted_cash":13.00,"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":49.80,"discounted_cash":29.88,"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":"0250","type":"RC"},{"code":"25021-151-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.10,"discounted_cash":27.06,"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":2.77,"discounted_cash":1.66,"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":2.21,"discounted_cash":1.33,"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":2.69,"discounted_cash":1.61,"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":18.60,"discounted_cash":11.16,"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":19.93,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G POT IN DEXTROSE 60000 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1025-41","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":"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":23.26,"discounted_cash":13.96,"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":3.04,"discounted_cash":1.82,"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":151.25,"discounted_cash":90.75,"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":48.24,"discounted_cash":28.94,"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":82.50,"discounted_cash":49.50,"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":92.65,"discounted_cash":55.59,"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":64.93,"discounted_cash":38.96,"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":64.93,"discounted_cash":38.96,"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":112.95,"discounted_cash":67.77,"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":217.25,"discounted_cash":130.35,"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":"0250","type":"RC"},{"code":"0338-9159-30","type":"NDC"}],"standard_charges":[{"gross_charge":171.12,"discounted_cash":102.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":171.3,"discounted_cash":102.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-9553-24","type":"NDC"}],"standard_charges":[{"gross_charge":64.93,"discounted_cash":38.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-9553-50","type":"NDC"}],"standard_charges":[{"gross_charge":64.93,"discounted_cash":38.96,"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":"0338-9558-10","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":"AZATHIOPRINE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-1005-01","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-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-0007-10","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":"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":0.50,"discounted_cash":0.30,"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":"0409-1178-03","type":"NDC"}],"standard_charges":[{"gross_charge":101.79,"discounted_cash":61.07,"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":153.7,"discounted_cash":92.22,"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":162.35,"discounted_cash":97.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":162.65,"discounted_cash":97.59,"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":"0143-9333-01","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":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9333-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.36,"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":"0143-9357-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.57,"discounted_cash":33.34,"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":9.12,"discounted_cash":5.47,"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":86.26,"discounted_cash":51.76,"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":"0143-9575-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.45,"discounted_cash":0.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":81.95,"discounted_cash":49.17,"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":23.91,"discounted_cash":14.34,"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":1.10,"discounted_cash":0.66,"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":55.88,"discounted_cash":33.53,"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":83.5,"discounted_cash":50.1,"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":87.26,"discounted_cash":52.35,"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":"0143-9850-01","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":"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":11.1,"discounted_cash":6.66,"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":17.1,"discounted_cash":10.26,"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":26.51,"discounted_cash":15.91,"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":614.95,"discounted_cash":368.97,"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":158.39,"discounted_cash":95.03,"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":"0250","type":"RC"},{"code":"0338-0049-03","type":"NDC"}],"standard_charges":[{"gross_charge":157.49,"discounted_cash":94.49,"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":150.82,"discounted_cash":90.50,"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":133.68,"discounted_cash":80.21,"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":83.83,"discounted_cash":50.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.77,"discounted_cash":7.06,"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":15.37,"discounted_cash":9.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":89.45,"discounted_cash":53.67,"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":0.74,"discounted_cash":0.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":81.35,"discounted_cash":48.81,"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":"0409-4277-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.43,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":84.35,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":81.58,"discounted_cash":48.95,"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":0.56,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":86.71,"discounted_cash":52.02,"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":0.57,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":92.6,"discounted_cash":55.56,"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":0.54,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":92.50,"discounted_cash":55.50,"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":"0409-4444-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.29,"discounted_cash":31.98,"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":85.65,"discounted_cash":51.39,"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":170.99,"discounted_cash":102.59,"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":"0409-6653-18","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":"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":80.70,"discounted_cash":48.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-9094-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.92,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.00,"discounted_cash":4.80,"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":82.77,"discounted_cash":49.66,"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":17.21,"discounted_cash":10.33,"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":375.41,"discounted_cash":225.25,"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":9.26,"discounted_cash":5.55,"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":1.65,"discounted_cash":0.99,"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":"0517-1001-25","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":"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":89.45,"discounted_cash":53.67,"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":"0409-4215-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.69,"discounted_cash":37.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3515-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.10,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":55.22,"discounted_cash":33.13,"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":83.95,"discounted_cash":50.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.90,"discounted_cash":5.94,"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":"0409-1312-03","type":"NDC"}],"standard_charges":[{"gross_charge":81.05,"discounted_cash":48.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.90,"discounted_cash":3.54,"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":"0409-1312-30","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":"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":14.88,"discounted_cash":8.93,"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":"0409-1560-18","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":"BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1623-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.47,"discounted_cash":63.88,"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":1.18,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39822-5525-2","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":"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":86.64,"discounted_cash":51.98,"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":"0409-2267-20","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":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2305-04","type":"NDC"}],"standard_charges":[{"gross_charge":28.23,"discounted_cash":16.94,"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":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-2305-05","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":"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":7.44,"discounted_cash":4.46,"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":"0409-3183-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.24,"discounted_cash":0.14,"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":81.23,"discounted_cash":48.74,"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":81.00,"discounted_cash":48.60,"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":"0409-1890-13","type":"NDC"}],"standard_charges":[{"gross_charge":95.78,"discounted_cash":57.47,"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":"0250","type":"RC"},{"code":"42023-116-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.95,"discounted_cash":25.77,"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":15.50,"discounted_cash":9.30,"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":39.28,"discounted_cash":23.57,"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":0.55,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.72,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":104.89,"discounted_cash":62.94,"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":"63323-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.60,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":114.95,"discounted_cash":68.97,"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":"63323-489-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.41,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":125.23,"discounted_cash":75.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.52,"discounted_cash":0.31,"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":2.15,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":48.34,"discounted_cash":29.01,"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":0.39,"discounted_cash":0.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":118.09,"discounted_cash":70.86,"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":2.14,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":84.11,"discounted_cash":50.46,"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":0.39,"discounted_cash":0.23,"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":0.39,"discounted_cash":0.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":41.95,"discounted_cash":25.17,"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":"63323-495-09","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":1.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":26.16,"discounted_cash":15.70,"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":"63323-508-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.92,"discounted_cash":5.96,"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":6.84,"discounted_cash":4.10,"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":2.50,"discounted_cash":1.50,"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":199.95,"discounted_cash":119.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-593-03","type":"NDC"}],"standard_charges":[{"gross_charge":1032.85,"discounted_cash":619.71,"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":104.72,"discounted_cash":62.83,"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":"63323-616-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.04,"discounted_cash":10.22,"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":"63323-664-00","type":"NDC"}],"standard_charges":[{"gross_charge":86.12,"discounted_cash":51.68,"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":0.48,"discounted_cash":0.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":91.19,"discounted_cash":54.71,"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":42.74,"discounted_cash":25.65,"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":"63323-482-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.85,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":84.25,"discounted_cash":50.55,"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":"63323-467-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.37,"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":1.04,"discounted_cash":0.62,"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":1.88,"discounted_cash":1.13,"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":"63323-280-03","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":2.52,"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":9.26,"discounted_cash":5.55,"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":63.37,"discounted_cash":38.02,"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":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-286-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.67,"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":"63323-286-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.53,"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":1.56,"discounted_cash":0.94,"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":0.92,"discounted_cash":0.55,"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":"63323-376-00","type":"NDC"}],"standard_charges":[{"gross_charge":34.95,"discounted_cash":20.97,"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":13.29,"discounted_cash":7.97,"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":"63323-398-41","type":"NDC"}],"standard_charges":[{"gross_charge":90.6,"discounted_cash":54.36,"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":47.65,"discounted_cash":28.59,"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":1.16,"discounted_cash":0.69,"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":2.03,"discounted_cash":1.22,"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":"63323-464-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.73,"discounted_cash":0.44,"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":0.48,"discounted_cash":0.29,"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":0.88,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROPROCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-477-01","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":"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":37.85,"discounted_cash":22.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 10 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-695-04","type":"NDC"}],"standard_charges":[{"gross_charge":43.38,"discounted_cash":26.03,"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":"63323-729-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":1.56,"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":14.67,"discounted_cash":8.80,"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":"0250","type":"RC"},{"code":"67457-426-00","type":"NDC"}],"standard_charges":[{"gross_charge":80.05,"discounted_cash":48.03,"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":1.02,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":76.95,"discounted_cash":46.17,"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":"67457-473-00","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":"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":11.06,"discounted_cash":6.63,"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":10223.75,"discounted_cash":6134.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.25 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-823-12","type":"NDC"}],"standard_charges":[{"gross_charge":49.80,"discounted_cash":29.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.20,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67457-824-15","type":"NDC"}],"standard_charges":[{"gross_charge":54.93,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.10,"discounted_cash":0.66,"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":11.4,"discounted_cash":6.84,"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":"67919-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.47,"discounted_cash":2.08,"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":654.25,"discounted_cash":392.55,"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":6.59,"discounted_cash":3.95,"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":4.6,"discounted_cash":2.76,"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":10.15,"discounted_cash":6.09,"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":21.6,"discounted_cash":12.96,"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":20.48,"discounted_cash":12.28,"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":"67457-385-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.29,"discounted_cash":14.58,"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":"67457-352-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.44,"discounted_cash":18.86,"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":"67457-349-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.05,"discounted_cash":37.23,"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":"67457-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":67.88,"discounted_cash":40.72,"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":1.02,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":76.40,"discounted_cash":45.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-852-25","type":"NDC"}],"standard_charges":[{"gross_charge":93.55,"discounted_cash":56.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.36,"discounted_cash":5.61,"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":45.23,"discounted_cash":27.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 200 MCG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-890-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.57,"discounted_cash":27.94,"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":"63323-930-00","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":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-963-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.23,"discounted_cash":4.94,"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":4.32,"discounted_cash":2.59,"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":8.53,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPIVACAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.14,"discounted_cash":24.08,"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":"0250","type":"RC"},{"code":"63323-983-53","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":"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":11.27,"discounted_cash":6.76,"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":17.93,"discounted_cash":10.76,"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":7.09,"discounted_cash":4.26,"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":6.86,"discounted_cash":4.12,"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":"65250-133-10","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":"ONDANSETRON 4 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-390-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.31,"discounted_cash":12.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":85.25,"discounted_cash":51.15,"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":0.62,"discounted_cash":0.37,"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":90.65,"discounted_cash":54.39,"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":106.95,"discounted_cash":64.17,"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":11.94,"discounted_cash":7.16,"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":"0143-9331-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.44,"discounted_cash":0.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-203-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.50,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":56.1,"discounted_cash":33.66,"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":"63323-201-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.70,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":63.26,"discounted_cash":37.95,"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":"44567-235-25","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":"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":49.25,"discounted_cash":29.55,"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":28.31,"discounted_cash":16.99,"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":"0250","type":"RC"},{"code":"44567-311-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.41,"discounted_cash":6.25,"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":64.88,"discounted_cash":38.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"44567-502-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":1.12,"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":2.63,"discounted_cash":1.58,"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":2.22,"discounted_cash":1.33,"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":1.50,"discounted_cash":0.90,"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":12.45,"discounted_cash":7.47,"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":461.4,"discounted_cash":276.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALTEPLASE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50242-085-27","type":"NDC"}],"standard_charges":[{"gross_charge":475.89,"discounted_cash":285.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE PF 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-6001-1","type":"NDC"}],"standard_charges":[{"gross_charge":31.94,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE PF 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51754-6001-4","type":"NDC"}],"standard_charges":[{"gross_charge":25.44,"discounted_cash":15.26,"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":"51862-460-01","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":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-144-99","type":"NDC"}],"standard_charges":[{"gross_charge":149.1,"discounted_cash":89.46,"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":11.60,"discounted_cash":6.96,"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":22.18,"discounted_cash":13.31,"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":7.04,"discounted_cash":4.22,"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":"44206-439-40","type":"NDC"}],"standard_charges":[{"gross_charge":431.63,"discounted_cash":258.98,"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":87.61,"discounted_cash":52.57,"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":"44206-438-92","type":"NDC"}],"standard_charges":[{"gross_charge":416.88,"discounted_cash":250.13,"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":553.65,"discounted_cash":332.19,"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":260.2,"discounted_cash":156.12,"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":260.2,"discounted_cash":156.12,"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":152.10,"discounted_cash":91.26,"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":146.51,"discounted_cash":87.90,"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":"43066-015-01","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":"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":1.27,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":507.95,"discounted_cash":304.77,"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":"43066-019-01","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":"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":0.65,"discounted_cash":0.39,"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":56.24,"discounted_cash":33.74,"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":27.30,"discounted_cash":16.38,"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":1.57,"discounted_cash":0.94,"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":1.00,"discounted_cash":0.60,"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":"43598-405-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.30,"discounted_cash":15.78,"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":148.68,"discounted_cash":89.21,"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":551.67,"discounted_cash":331.00,"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":479.48,"discounted_cash":287.69,"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":546.33,"discounted_cash":327.80,"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":492.01,"discounted_cash":295.20,"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":553.65,"discounted_cash":332.19,"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":420.45,"discounted_cash":252.27,"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":59.98,"discounted_cash":35.99,"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":"55150-121-50","type":"NDC"}],"standard_charges":[{"gross_charge":40.16,"discounted_cash":24.10,"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":117.6,"discounted_cash":70.56,"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":35.81,"discounted_cash":21.49,"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":1.62,"discounted_cash":0.97,"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":0.78,"discounted_cash":0.47,"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":0.25,"discounted_cash":0.15,"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":7.06,"discounted_cash":4.23,"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":0.69,"discounted_cash":0.42,"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":7.48,"discounted_cash":4.49,"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":"62332-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.4,"discounted_cash":48.84,"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":27.49,"discounted_cash":16.49,"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":"63323-013-01","type":"NDC"}],"standard_charges":[{"gross_charge":56.9,"discounted_cash":34.14,"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":31.93,"discounted_cash":19.16,"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":"63323-064-41","type":"NDC"}],"standard_charges":[{"gross_charge":21.66,"discounted_cash":13.00,"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":48.49,"discounted_cash":29.09,"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":"63323-108-00","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":"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":1.73,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":172.75,"discounted_cash":103.65,"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":88.25,"discounted_cash":52.95,"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":58.43,"discounted_cash":35.06,"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":"63323-162-16","type":"NDC"}],"standard_charges":[{"gross_charge":79.25,"discounted_cash":47.55,"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":15.05,"discounted_cash":9.03,"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":35.81,"discounted_cash":21.49,"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":43.18,"discounted_cash":25.91,"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":55.68,"discounted_cash":33.40,"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":55.65,"discounted_cash":33.39,"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":9.82,"discounted_cash":5.89,"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":"55150-250-50","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":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"55150-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":82.57,"discounted_cash":49.54,"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":"0250","type":"RC"},{"code":"55513-144-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.55,"discounted_cash":39.93,"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":20.05,"discounted_cash":12.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":21.3,"discounted_cash":12.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":80.82,"discounted_cash":48.49,"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":146.5,"discounted_cash":87.9,"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":184.95,"discounted_cash":110.97,"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":"0250","type":"RC"},{"code":"58160-831-03","type":"NDC"}],"standard_charges":[{"gross_charge":426.1,"discounted_cash":255.66,"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":"0250","type":"RC"},{"code":"59338-775-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.79,"discounted_cash":7.67,"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":6.91,"discounted_cash":4.15,"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":8.36,"discounted_cash":5.01,"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":"60505-4632-3","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":"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":20.02,"discounted_cash":12.01,"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":19.92,"discounted_cash":11.95,"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":27.07,"discounted_cash":16.24,"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":69.48,"discounted_cash":41.68,"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":51.28,"discounted_cash":30.76,"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":258.07,"discounted_cash":154.84,"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":1.69,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":168.25,"discounted_cash":100.95,"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":"0143-9331-01","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":"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":1.00,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":44.41,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDO-EPINEPHRINE-TETRACAINE 4-0.05-0.5 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70092-1611-44","type":"NDC"}],"standard_charges":[{"gross_charge":73.26,"discounted_cash":43.96,"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":"70092-1684-48","type":"NDC"}],"standard_charges":[{"gross_charge":171.05,"discounted_cash":102.63,"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":"70092-1687-48","type":"NDC"}],"standard_charges":[{"gross_charge":169.29,"discounted_cash":101.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CANNABIDIOL 100 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70127-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":341.5,"discounted_cash":204.9,"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":81.88,"discounted_cash":49.12,"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":"70700-268-94","type":"NDC"}],"standard_charges":[{"gross_charge":357.65,"discounted_cash":214.59,"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":"70710-1165-6","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":"BACLOFEN 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70710-1286-1","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":14.25,"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":"70710-1460-2","type":"NDC"}],"standard_charges":[{"gross_charge":108.9,"discounted_cash":65.34,"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":20.45,"discounted_cash":12.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAZOSIN HCL 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-440-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.27,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-609-15","type":"NDC"}],"standard_charges":[{"gross_charge":571.35,"discounted_cash":342.81,"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":13.58,"discounted_cash":8.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":15.22,"discounted_cash":9.13,"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":113.1,"discounted_cash":67.86,"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":78.01,"discounted_cash":46.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.24,"discounted_cash":1.94,"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":113.1,"discounted_cash":67.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":112.36,"discounted_cash":67.42,"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":235.42,"discounted_cash":141.25,"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":"70954-135-20","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":"HYDROMORPHONE HCL-NACL 30-0.9 MG/30ML-% IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70092-1293-49","type":"NDC"}],"standard_charges":[{"gross_charge":179.95,"discounted_cash":107.97,"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":"70092-1099-49","type":"NDC"}],"standard_charges":[{"gross_charge":181.9,"discounted_cash":109.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPINEPHRINE 0.1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69374-544-10","type":"NDC"}],"standard_charges":[{"gross_charge":144.5,"discounted_cash":86.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69452-151-20","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":"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":16.75,"discounted_cash":10.05,"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":337.61,"discounted_cash":202.57,"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":8.82,"discounted_cash":5.29,"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":5.16,"discounted_cash":3.09,"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":24.25,"discounted_cash":14.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 650 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69918-301-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.22,"discounted_cash":13.33,"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":12.53,"discounted_cash":7.52,"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":255.0,"discounted_cash":153.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70069-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":130.8,"discounted_cash":78.48,"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":67.4,"discounted_cash":40.44,"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":89.2,"discounted_cash":53.52,"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":74.15,"discounted_cash":44.49,"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":363.85,"discounted_cash":218.31,"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":306.31,"discounted_cash":183.79,"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":176.45,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":165.94,"discounted_cash":99.56,"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":287.5,"discounted_cash":172.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CIT-ROPIVACAINE-NACL 0.4-0.1-0.9 MG/200ML-% EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70092-1207-37","type":"NDC"}],"standard_charges":[{"gross_charge":323.15,"discounted_cash":193.89,"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":"69367-307-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.13,"discounted_cash":10.28,"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":"70954-159-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.54,"discounted_cash":10.52,"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":62.5,"discounted_cash":37.5,"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":"71399-8245-3","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.6,"discounted_cash":4.56,"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":"71399-8460-2","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"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":"71839-142-01","type":"NDC"}],"standard_charges":[{"gross_charge":196.9,"discounted_cash":118.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":157.25,"discounted_cash":94.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AQUAPHOR ADVANCED THERAPY EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72140-03711","type":"NDC"}],"standard_charges":[{"gross_charge":82.2,"discounted_cash":49.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EUCERIN ORIGINAL HEALING EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72140-03868","type":"NDC"}],"standard_charges":[{"gross_charge":74.5,"discounted_cash":44.7,"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":36.39,"discounted_cash":21.83,"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":61.40,"discounted_cash":36.84,"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":50.65,"discounted_cash":30.39,"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":19.72,"discounted_cash":11.83,"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":7.45,"discounted_cash":4.47,"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":559.7,"discounted_cash":335.82,"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":"72578-001-18","type":"NDC"}],"standard_charges":[{"gross_charge":26.91,"discounted_cash":16.15,"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":"72578-089-01","type":"NDC"}],"standard_charges":[{"gross_charge":103.5,"discounted_cash":62.1,"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":10.81,"discounted_cash":6.49,"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":"72888-092-30","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":"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":8.65,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.95,"discounted_cash":4.77,"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":19.85,"discounted_cash":11.91,"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":34.26,"discounted_cash":20.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHOLECALCIFEROL 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71399-7401-5","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":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71399-0049-3","type":"NDC"}],"standard_charges":[{"gross_charge":95.2,"discounted_cash":57.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIMETHOPRIM 50 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":7.96,"discounted_cash":4.77,"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":"70954-564-10","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":"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":143.35,"discounted_cash":86.01,"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":208.18,"discounted_cash":124.91,"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":222.45,"discounted_cash":133.47,"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":221.16,"discounted_cash":132.70,"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":"71266-5250-1","type":"NDC"}],"standard_charges":[{"gross_charge":285.86,"discounted_cash":171.52,"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":96.70,"discounted_cash":58.02,"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":80.41,"discounted_cash":48.25,"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":80.53,"discounted_cash":48.32,"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":"71266-9170-5","type":"NDC"}],"standard_charges":[{"gross_charge":211.75,"discounted_cash":127.05,"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":191.35,"discounted_cash":114.81,"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":43.15,"discounted_cash":25.89,"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":97.45,"discounted_cash":58.47,"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":"71288-700-05","type":"NDC"}],"standard_charges":[{"gross_charge":89.64,"discounted_cash":53.79,"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":56.45,"discounted_cash":33.87,"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":416.88,"discounted_cash":250.12,"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":106.13,"discounted_cash":63.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":94.50,"discounted_cash":56.70,"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":16.87,"discounted_cash":10.12,"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":"69367-224-09","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":6.24,"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":"69367-162-04","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":"PROBIOTIC PO PACK WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69355-412-02","type":"NDC"}],"standard_charges":[{"gross_charge":17.18,"discounted_cash":10.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":17.0,"discounted_cash":10.2,"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":"68084-895-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPYLTHIOURACIL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-964-95","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":"PRAZOSIN HCL 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-996-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.15,"discounted_cash":7.89,"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":10.38,"discounted_cash":6.22,"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":"68094-034-59","type":"NDC"}],"standard_charges":[{"gross_charge":14.7,"discounted_cash":8.82,"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":"68094-043-59","type":"NDC"}],"standard_charges":[{"gross_charge":44.97,"discounted_cash":26.98,"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":24.13,"discounted_cash":14.48,"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":"68094-120-59","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":10.44,"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":9.2,"discounted_cash":5.52,"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":9.13,"discounted_cash":5.48,"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":115.59,"discounted_cash":69.35,"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":604.7,"discounted_cash":362.82,"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":"68180-590-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.75,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"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":56.95,"discounted_cash":34.17,"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":"68180-723-04","type":"NDC"}],"standard_charges":[{"gross_charge":19.05,"discounted_cash":11.43,"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":"68180-861-06","type":"NDC"}],"standard_charges":[{"gross_charge":30.90,"discounted_cash":18.54,"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":8.87,"discounted_cash":5.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TOPIRAMATE 15 MG PO CAP-SPRINKLE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-004-14","type":"NDC"}],"standard_charges":[{"gross_charge":9.92,"discounted_cash":5.95,"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":"68382-097-06","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-882-11","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":"VENLAFAXINE HCL 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68382-101-01","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":"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":8.52,"discounted_cash":5.11,"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":"68084-851-95","type":"NDC"}],"standard_charges":[{"gross_charge":7.49,"discounted_cash":4.50,"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":19.06,"discounted_cash":11.44,"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":"68084-704-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.15,"discounted_cash":7.89,"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":9.61,"discounted_cash":5.77,"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":19.57,"discounted_cash":11.74,"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":21.37,"discounted_cash":12.82,"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":"68084-723-11","type":"NDC"}],"standard_charges":[{"gross_charge":41.72,"discounted_cash":25.04,"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":160.95,"discounted_cash":96.57,"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":"68084-750-95","type":"NDC"}],"standard_charges":[{"gross_charge":8.64,"discounted_cash":5.18,"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":"68084-752-95","type":"NDC"}],"standard_charges":[{"gross_charge":97.87,"discounted_cash":58.72,"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":9.96,"discounted_cash":5.98,"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":11.45,"discounted_cash":6.87,"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":"68084-753-95","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":"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":9.91,"discounted_cash":5.94,"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":"68084-782-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.7,"discounted_cash":10.62,"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":"68084-788-95","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":"METHYLPHENIDATE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-805-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.21,"discounted_cash":6.72,"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":"68084-808-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL 37.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-844-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.27,"discounted_cash":6.16,"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":"68084-845-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":7.35,"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":13.49,"discounted_cash":8.09,"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":"68382-444-05","type":"NDC"}],"standard_charges":[{"gross_charge":37.34,"discounted_cash":22.40,"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":"68382-528-60","type":"NDC"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":10.89,"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":12.5,"discounted_cash":7.5,"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":357.65,"discounted_cash":214.59,"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":30.25,"discounted_cash":18.15,"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":17.55,"discounted_cash":10.53,"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":"69238-1484-3","type":"NDC"}],"standard_charges":[{"gross_charge":49.13,"discounted_cash":29.48,"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":119.46,"discounted_cash":71.68,"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":40.92,"discounted_cash":24.55,"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":"69238-1835-1","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":"PROPRANOLOL HCL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69238-2079-1","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 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":7.95,"discounted_cash":4.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69315-139-01","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":"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":8.0,"discounted_cash":4.8,"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":8.72,"discounted_cash":5.23,"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":75.6,"discounted_cash":45.36,"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":"69315-904-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.48,"discounted_cash":5.69,"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":8.88,"discounted_cash":5.33,"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":6.96,"discounted_cash":4.18,"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":"69339-151-05","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":"CINACALCET HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"69097-410-02","type":"NDC"}],"standard_charges":[{"gross_charge":110.47,"discounted_cash":66.28,"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":"69097-319-87","type":"NDC"}],"standard_charges":[{"gross_charge":43.79,"discounted_cash":26.28,"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":11.95,"discounted_cash":7.17,"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":10.65,"discounted_cash":6.39,"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":11.5,"discounted_cash":6.9,"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":90.42,"discounted_cash":54.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-138-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.71,"discounted_cash":8.23,"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":"68462-157-40","type":"NDC"}],"standard_charges":[{"gross_charge":78.14,"discounted_cash":46.89,"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":189.9,"discounted_cash":113.94,"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":8.05,"discounted_cash":4.83,"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":8.95,"discounted_cash":5.37,"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":2288.45,"discounted_cash":1373.07,"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":5.32,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THEOPHYLLINE ER 200 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-380-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.8,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.74,"discounted_cash":7.65,"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":16.28,"discounted_cash":9.77,"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":133.05,"discounted_cash":79.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THEOPHYLLINE ER 150 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-721-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.3,"discounted_cash":8.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":18.98,"discounted_cash":11.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VARENICLINE TARTRATE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68462-894-56","type":"NDC"}],"standard_charges":[{"gross_charge":36.9,"discounted_cash":22.14,"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":132.41,"discounted_cash":79.44,"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":"68585-00575","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":"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":10.9,"discounted_cash":6.54,"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":"75826-139-00","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":"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":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL 64.8 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"75826-141-10","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":"IOPAMIDOL 41 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0270-1314-30","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"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":10.0,"discounted_cash":6.0,"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":10.0,"discounted_cash":6.0,"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":14.0,"discounted_cash":8.4,"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":14.0,"discounted_cash":8.4,"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":14.0,"discounted_cash":8.4,"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":"0270-1315-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":8.4,"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":14.0,"discounted_cash":8.4,"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":11.0,"discounted_cash":6.6,"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":14.0,"discounted_cash":8.4,"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":14.0,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GADOXETATE DISODIUM 0.25 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50419-320-05","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":"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":"0270-1111-04","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":"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":20.0,"discounted_cash":12.0,"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":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":"0270-5164-13","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":"0270-5164-13","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":"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":18.0,"discounted_cash":10.8,"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":61.19,"discounted_cash":36.71,"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":18.0,"discounted_cash":10.8,"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":8.0,"discounted_cash":4.8,"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":18.26,"discounted_cash":10.96,"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":18.55,"discounted_cash":11.13,"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":9.30,"discounted_cash":5.58,"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":17.26,"discounted_cash":10.36,"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":15.91,"discounted_cash":9.55,"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":185.22,"discounted_cash":111.13,"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":179.94,"discounted_cash":107.97,"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":185.95,"discounted_cash":111.57,"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":"0258","type":"RC"},{"code":"0338-9159-30","type":"NDC"}],"standard_charges":[{"gross_charge":170.41,"discounted_cash":102.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":171.29,"discounted_cash":102.77,"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":330.8,"discounted_cash":198.48,"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":330.8,"discounted_cash":198.48,"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":"0258","type":"RC"},{"code":"0338-9543-05","type":"NDC"}],"standard_charges":[{"gross_charge":168.36,"discounted_cash":101.01,"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":169.35,"discounted_cash":101.61,"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":"0258","type":"RC"},{"code":"0338-9791-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.96,"discounted_cash":95.38,"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":"0990-7109-09","type":"NDC"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":105.6,"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":79.67,"discounted_cash":47.80,"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":179.3,"discounted_cash":107.58,"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":156.0,"discounted_cash":93.6,"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":8.0,"discounted_cash":4.8,"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":10.07,"discounted_cash":6.04,"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":7.50,"discounted_cash":4.50,"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":46.88,"discounted_cash":28.13,"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":45.58,"discounted_cash":27.35,"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":"0069-6001-02","type":"NDC"}],"standard_charges":[{"gross_charge":115.4,"discounted_cash":69.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0069-6001-10","type":"NDC"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"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":"0075-0621-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.47,"discounted_cash":27.28,"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":"0075-0622-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.11,"discounted_cash":28.87,"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":"0075-0623-03","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":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0075-2915-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.61,"discounted_cash":8.77,"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":6.6,"discounted_cash":3.96,"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":24.9,"discounted_cash":14.94,"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":"0250","type":"RC"},{"code":"0121-0759-08","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":"CEFAZOLIN SODIUM 3 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9140-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 3 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9140-25","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9153-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.93,"discounted_cash":32.96,"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":91.37,"discounted_cash":54.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.85,"discounted_cash":1.11,"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":44.37,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.92,"discounted_cash":0.55,"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":2.92,"discounted_cash":1.75,"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":3.02,"discounted_cash":1.81,"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":"0054-8740-25","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":"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":1.15,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.46,"discounted_cash":1.48,"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":"0250","type":"RC"},{"code":"0002-7737-01","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":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8215-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.33,"discounted_cash":3.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1416.9,"discounted_cash":850.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0002-8215-17","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"discounted_cash":4.93,"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":3.34,"discounted_cash":2.01,"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":"0002-8315-17","type":"NDC"}],"standard_charges":[{"gross_charge":4.80,"discounted_cash":2.88,"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":2.29,"discounted_cash":1.37,"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":1048.38,"discounted_cash":629.03,"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":95.59,"discounted_cash":57.35,"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":134.32,"discounted_cash":80.59,"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":182.65,"discounted_cash":109.59,"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":12.79,"discounted_cash":7.68,"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":7.59,"discounted_cash":4.56,"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":6.69,"discounted_cash":4.02,"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":1.22,"discounted_cash":0.73,"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":91.5,"discounted_cash":54.9,"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":91.5,"discounted_cash":54.9,"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":27.93,"discounted_cash":16.76,"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":65.2,"discounted_cash":39.12,"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":"0054-0017-20","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":"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":12.70,"discounted_cash":7.62,"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":1.07,"discounted_cash":0.64,"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":166.0,"discounted_cash":99.6,"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":"0338-0357-02","type":"NDC"}],"standard_charges":[{"gross_charge":202.47,"discounted_cash":121.48,"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":8.25,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.59,"discounted_cash":4.55,"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":8.11,"discounted_cash":4.86,"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":"77333-827-10","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":"SODIUM BICARBONATE 650 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-831-25","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":"SODIUM CHLORIDE 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-844-10","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":"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":7.25,"discounted_cash":4.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-12 500 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-937-25","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":"PYRIDOXINE HCL 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"77333-940-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOXINE HCL 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":7.32,"discounted_cash":4.39,"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"},{"gross_charge":7.75,"discounted_cash":4.65,"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":"77333-983-10","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":"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":8.2,"discounted_cash":4.92,"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":8.27,"discounted_cash":4.96,"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":12.58,"discounted_cash":7.55,"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":12.40,"discounted_cash":7.44,"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":"80425-269-01","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":"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":7.6,"discounted_cash":4.56,"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":"77333-308-10","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":"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":127.29,"discounted_cash":76.37,"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":"75834-080-90","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":6.24,"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":10.52,"discounted_cash":6.31,"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":12.58,"discounted_cash":7.55,"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":8.76,"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":123.15,"discounted_cash":73.89,"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":202.2,"discounted_cash":121.32,"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":9.85,"discounted_cash":5.91,"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":10.28,"discounted_cash":6.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 7 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"76204-021-60","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":"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":13.34,"discounted_cash":8.01,"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":10.88,"discounted_cash":6.53,"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":"76204-200-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.81,"discounted_cash":5.89,"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":"76204-300-03","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":"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":14.67,"discounted_cash":8.80,"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":13.8,"discounted_cash":8.28,"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":"76204-900-01","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":"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":13.71,"discounted_cash":8.23,"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":193.66,"discounted_cash":116.19,"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":98.23,"discounted_cash":58.94,"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":"76385-106-17","type":"NDC"}],"standard_charges":[{"gross_charge":92.5,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"B COMPLEX-C PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"80681-12600","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":"SODIUM CHLORIDE 0.9 % IR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"8080-102200","type":"NDC"}],"standard_charges":[{"gross_charge":144.9,"discounted_cash":86.94,"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":165.74,"discounted_cash":99.44,"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":150.31,"discounted_cash":90.19,"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":150.69,"discounted_cash":90.41,"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":166.0,"discounted_cash":99.6,"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":171.25,"discounted_cash":102.75,"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":168.99,"discounted_cash":101.39,"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":158.58,"discounted_cash":95.15,"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":157.98,"discounted_cash":94.79,"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":"0338-0049-04","type":"NDC"}],"standard_charges":[{"gross_charge":161.92,"discounted_cash":97.15,"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":148.10,"discounted_cash":88.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":150.25,"discounted_cash":90.15,"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":149.09,"discounted_cash":89.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":153.75,"discounted_cash":92.25,"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":"0338-0062-30","type":"NDC"}],"standard_charges":[{"gross_charge":163.5,"discounted_cash":98.1,"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":166.0,"discounted_cash":99.6,"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":165.03,"discounted_cash":99.02,"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":"0338-0089-04","type":"NDC"}],"standard_charges":[{"gross_charge":82.11,"discounted_cash":49.27,"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":161.85,"discounted_cash":97.11,"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":166.0,"discounted_cash":99.6,"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":159.48,"discounted_cash":95.69,"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":158.28,"discounted_cash":94.97,"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":154.35,"discounted_cash":92.61,"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":"0258","type":"RC"},{"code":"0264-7800-00","type":"NDC"}],"standard_charges":[{"gross_charge":152.7,"discounted_cash":91.62,"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":49.7,"discounted_cash":29.82,"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":"81033-501-15","type":"NDC"}],"standard_charges":[{"gross_charge":15.92,"discounted_cash":9.55,"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":504.25,"discounted_cash":302.55,"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":"81964-203-69","type":"NDC"}],"standard_charges":[{"gross_charge":21.78,"discounted_cash":13.06,"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":7.86,"discounted_cash":4.71,"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":23.8,"discounted_cash":14.28,"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":"82625-8801-1","type":"NDC"}],"standard_charges":[{"gross_charge":65.86,"discounted_cash":39.52,"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":"87701-40754","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":"CYANOCOBALAMIN 2500 MCG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"87701-41153","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":"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":179.3,"discounted_cash":107.58,"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":"87701-43418","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":"SODIUM CHLORIDE 0.45 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-0043-04","type":"NDC"}],"standard_charges":[{"gross_charge":169.35,"discounted_cash":101.61,"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":"0250","type":"RC"},{"code":"0338-0085-04","type":"NDC"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":99.6,"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":"0264-5802-00","type":"NDC"}],"standard_charges":[{"gross_charge":152.7,"discounted_cash":91.62,"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":"0264-7510-00","type":"NDC"}],"standard_charges":[{"gross_charge":159.35,"discounted_cash":95.61,"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":"0264-7652-00","type":"NDC"}],"standard_charges":[{"gross_charge":165.16,"discounted_cash":99.10,"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":7.55,"discounted_cash":4.53,"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":35.06,"discounted_cash":21.04,"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":"68462-897-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":6.47,"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":"68516-5214-9","type":"NDC"}],"standard_charges":[{"gross_charge":328.3,"discounted_cash":196.98,"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":69.48,"discounted_cash":41.68,"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":51.28,"discounted_cash":30.76,"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":55.61,"discounted_cash":33.37,"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":55.77,"discounted_cash":33.46,"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":85.77,"discounted_cash":51.46,"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":81.30,"discounted_cash":48.78,"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":43.18,"discounted_cash":25.91,"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":35.81,"discounted_cash":21.49,"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":35.91,"discounted_cash":21.54,"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":1.56,"discounted_cash":0.94,"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":0.72,"discounted_cash":0.43,"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":0.23,"discounted_cash":0.14,"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":"60687-252-40","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":9.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-438-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60687-438-11","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":"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":7.37,"discounted_cash":4.42,"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":"60687-718-11","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":"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":112.18,"discounted_cash":67.31,"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":7.50,"discounted_cash":4.50,"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":24.33,"discounted_cash":14.60,"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":"62332-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.81,"discounted_cash":39.49,"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":19.64,"discounted_cash":11.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYCLOSPORINE 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"60505-0133-0","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":"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":146.5,"discounted_cash":87.9,"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":631.68,"discounted_cash":379.01,"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":"57894-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":257.85,"discounted_cash":154.71,"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":216.13,"discounted_cash":129.68,"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":96.61,"discounted_cash":57.97,"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":185.4,"discounted_cash":111.24,"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":186.48,"discounted_cash":111.89,"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":"0636","type":"RC"},{"code":"58160-820-52","type":"NDC"}],"standard_charges":[{"gross_charge":185.72,"discounted_cash":111.44,"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":"58160-824-15","type":"NDC"}],"standard_charges":[{"gross_charge":436.35,"discounted_cash":261.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MENINGOCOCCAL A C Y&W-135 OLIG IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"58160-827-03","type":"NDC"}],"standard_charges":[{"gross_charge":672.15,"discounted_cash":403.29,"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":431.41,"discounted_cash":258.85,"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":245.9,"discounted_cash":147.54,"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":257.85,"discounted_cash":154.71,"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":"58468-0030-1","type":"NDC"}],"standard_charges":[{"gross_charge":10801.22,"discounted_cash":6480.73,"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":12.79,"discounted_cash":7.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EPOETIN ALFA 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"59676-304-00","type":"NDC"}],"standard_charges":[{"gross_charge":110.74,"discounted_cash":66.44,"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":5.62,"discounted_cash":3.38,"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":5.09,"discounted_cash":3.05,"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":6.29,"discounted_cash":3.77,"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":19.75,"discounted_cash":11.85,"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":21.11,"discounted_cash":12.67,"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":"63323-010-01","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":"OXYTOCIN 10 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-012-03","type":"NDC"}],"standard_charges":[{"gross_charge":54.41,"discounted_cash":32.65,"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":9.52,"discounted_cash":5.71,"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":64.36,"discounted_cash":38.61,"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":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-285-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":2.06,"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":"63323-286-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.63,"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":"63323-286-11","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":"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":1.48,"discounted_cash":0.89,"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":1.46,"discounted_cash":0.87,"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":"63323-360-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.68,"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":"63323-376-00","type":"NDC"}],"standard_charges":[{"gross_charge":23.54,"discounted_cash":14.13,"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":13.29,"discounted_cash":7.97,"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":"63323-398-41","type":"NDC"}],"standard_charges":[{"gross_charge":90.6,"discounted_cash":54.36,"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":21.44,"discounted_cash":12.86,"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":14.52,"discounted_cash":8.71,"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":27.90,"discounted_cash":16.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-412-18","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":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-412-25","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":"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":1.13,"discounted_cash":0.68,"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":2.49,"discounted_cash":1.49,"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":"0636","type":"RC"},{"code":"63323-280-03","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":"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":31.39,"discounted_cash":18.83,"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":270.9,"discounted_cash":162.54,"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":1.04,"discounted_cash":0.62,"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":"63323-013-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.33,"discounted_cash":30.80,"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":"63323-024-25","type":"NDC"}],"standard_charges":[{"gross_charge":52.68,"discounted_cash":31.60,"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":23.58,"discounted_cash":14.14,"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":48.83,"discounted_cash":29.30,"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":2.24,"discounted_cash":1.34,"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":"63323-108-00","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":"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":1.73,"discounted_cash":1.04,"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":75.71,"discounted_cash":45.43,"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":54.59,"discounted_cash":32.75,"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":"63323-162-16","type":"NDC"}],"standard_charges":[{"gross_charge":59.75,"discounted_cash":35.85,"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":14.96,"discounted_cash":8.97,"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":"63323-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.49,"discounted_cash":53.70,"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":156.2,"discounted_cash":93.72,"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":"63323-201-03","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 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-201-10","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":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-203-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.86,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.50,"discounted_cash":0.90,"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":11.88,"discounted_cash":7.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPIVACAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.93,"discounted_cash":20.96,"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":1.87,"discounted_cash":1.12,"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":66.83,"discounted_cash":40.10,"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":66.85,"discounted_cash":40.11,"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":65.11,"discounted_cash":39.07,"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":429.90,"discounted_cash":257.94,"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":"44206-438-20","type":"NDC"}],"standard_charges":[{"gross_charge":427.91,"discounted_cash":256.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":425.08,"discounted_cash":255.05,"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":"44206-438-92","type":"NDC"}],"standard_charges":[{"gross_charge":425.14,"discounted_cash":255.09,"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":"44206-439-40","type":"NDC"}],"standard_charges":[{"gross_charge":420.61,"discounted_cash":252.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":419.24,"discounted_cash":251.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":423.67,"discounted_cash":254.20,"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":"44206-439-93","type":"NDC"}],"standard_charges":[{"gross_charge":423.37,"discounted_cash":254.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":426.01,"discounted_cash":255.61,"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":"0636","type":"RC"},{"code":"44567-235-25","type":"NDC"}],"standard_charges":[{"gross_charge":85.1,"discounted_cash":51.06,"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":49.35,"discounted_cash":29.61,"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":28.31,"discounted_cash":16.99,"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":10.62,"discounted_cash":6.37,"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":64.59,"discounted_cash":38.76,"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":2.79,"discounted_cash":1.68,"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":2.22,"discounted_cash":1.33,"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":1.50,"discounted_cash":0.90,"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":12.45,"discounted_cash":7.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TILDRAKIZUMAB-ASMN 100 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"47335-177-95","type":"NDC"}],"standard_charges":[{"gross_charge":950.94,"discounted_cash":570.56,"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":430.59,"discounted_cash":258.35,"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":223.97,"discounted_cash":134.38,"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":435.28,"discounted_cash":261.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":425.21,"discounted_cash":255.13,"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":553.65,"discounted_cash":332.19,"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":150.76,"discounted_cash":90.46,"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":149.03,"discounted_cash":89.42,"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":"43066-015-01","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":"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":1.27,"discounted_cash":0.76,"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":"43066-019-01","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":"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":0.59,"discounted_cash":0.36,"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":55.63,"discounted_cash":33.38,"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":27.26,"discounted_cash":16.36,"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":1.57,"discounted_cash":0.94,"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":1.01,"discounted_cash":0.61,"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":"43598-405-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.96,"discounted_cash":14.38,"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":0.87,"discounted_cash":0.52,"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":133.11,"discounted_cash":79.86,"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":547.31,"discounted_cash":328.38,"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":453.34,"discounted_cash":272.01,"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":553.65,"discounted_cash":332.19,"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":466.62,"discounted_cash":279.97,"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":553.65,"discounted_cash":332.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BELIMUMAB 400 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"49401-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":284.43,"discounted_cash":170.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ZIDOVUDINE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"49702-213-26","type":"NDC"}],"standard_charges":[{"gross_charge":6.91,"discounted_cash":4.14,"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":248.41,"discounted_cash":149.05,"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":60.9,"discounted_cash":36.54,"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":60.93,"discounted_cash":36.56,"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":"55150-121-50","type":"NDC"}],"standard_charges":[{"gross_charge":40.16,"discounted_cash":24.10,"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":"55150-162-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.81,"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":0.89,"discounted_cash":0.53,"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":1.10,"discounted_cash":0.66,"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":117.6,"discounted_cash":70.56,"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":10.27,"discounted_cash":6.16,"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":"55150-250-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.54,"discounted_cash":0.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.57,"discounted_cash":0.34,"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":"55150-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROGESTERONE 50 MG/ML IM OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-306-10","type":"NDC"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":46.2,"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":"55150-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.18,"discounted_cash":8.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55150-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.55,"discounted_cash":82.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TEZEPELUMAB-EKKO 210 MG/1.91ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"55513-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":109.84,"discounted_cash":65.91,"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":42.84,"discounted_cash":25.71,"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":162.83,"discounted_cash":97.70,"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":166.88,"discounted_cash":100.13,"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":"55513-880-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.11,"discounted_cash":39.07,"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":96.55,"discounted_cash":57.93,"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":90.35,"discounted_cash":54.21,"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":"55111-681-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.15,"discounted_cash":14.49,"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":51.94,"discounted_cash":31.16,"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":438.99,"discounted_cash":263.39,"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":"0636","type":"RC"},{"code":"50242-044-13","type":"NDC"}],"standard_charges":[{"gross_charge":475.89,"discounted_cash":285.54,"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":508.01,"discounted_cash":304.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALTEPLASE 100 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"50242-085-27","type":"NDC"}],"standard_charges":[{"gross_charge":476.67,"discounted_cash":286.00,"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":804.70,"discounted_cash":482.82,"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":36.04,"discounted_cash":21.62,"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":362.35,"discounted_cash":217.41,"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":79.06,"discounted_cash":47.43,"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":0.75,"discounted_cash":0.45,"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":1648.12,"discounted_cash":988.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE PF 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51754-6001-4","type":"NDC"}],"standard_charges":[{"gross_charge":25.01,"discounted_cash":15.01,"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":"51991-144-99","type":"NDC"}],"standard_charges":[{"gross_charge":149.1,"discounted_cash":89.46,"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":13.05,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.09,"discounted_cash":4.85,"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":"54288-103-10","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":"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":12.64,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.32,"discounted_cash":9.79,"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":8.31,"discounted_cash":4.99,"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":9.16,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCOPYRROLATE PF 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"51754-6001-1","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":"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":0.43,"discounted_cash":0.26,"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":0.96,"discounted_cash":0.58,"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":0.45,"discounted_cash":0.27,"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":78.15,"discounted_cash":46.89,"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":78.15,"discounted_cash":46.89,"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":"70756-612-44","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":47.1,"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":"70756-612-60","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":47.1,"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":0.37,"discounted_cash":0.22,"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":"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":1.36,"discounted_cash":0.81,"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":37.51,"discounted_cash":22.51,"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":3.52,"discounted_cash":2.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":75.67,"discounted_cash":45.40,"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":"0636","type":"RC"},{"code":"71288-203-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":33.27,"discounted_cash":19.96,"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":0.41,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.94,"discounted_cash":4.76,"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":84.4,"discounted_cash":50.64,"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":33.05,"discounted_cash":19.83,"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":16.26,"discounted_cash":9.76,"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":"71288-404-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.61,"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":27.07,"discounted_cash":16.24,"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":"70594-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.37,"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":8.55,"discounted_cash":5.13,"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":15.0,"discounted_cash":9.0,"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":354.75,"discounted_cash":212.85,"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":24.44,"discounted_cash":14.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":25.58,"discounted_cash":15.35,"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":35.93,"discounted_cash":21.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":29.23,"discounted_cash":17.54,"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":"69452-309-20","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":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"69680-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.2,"discounted_cash":56.52,"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":"69918-700-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":6.93,"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":68.54,"discounted_cash":41.13,"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":"70069-061-01","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":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"70069-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.65,"discounted_cash":0.39,"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":"70069-671-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.81,"discounted_cash":59.88,"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":27.15,"discounted_cash":16.29,"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":2.82,"discounted_cash":1.69,"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":1.32,"discounted_cash":0.79,"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":1.43,"discounted_cash":0.86,"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":"70121-1577-1","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":"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":129.68,"discounted_cash":77.81,"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":225.4,"discounted_cash":135.24,"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":"70436-147-81","type":"NDC"}],"standard_charges":[{"gross_charge":225.4,"discounted_cash":135.24,"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":"70515-260-10","type":"NDC"}],"standard_charges":[{"gross_charge":424.98,"discounted_cash":254.99,"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":15.41,"discounted_cash":9.24,"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":29.32,"discounted_cash":17.59,"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":22.81,"discounted_cash":13.69,"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":7.15,"discounted_cash":4.29,"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":1.06,"discounted_cash":0.64,"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":94.89,"discounted_cash":56.93,"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":1.07,"discounted_cash":0.64,"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":34.46,"discounted_cash":20.68,"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":407.59,"discounted_cash":244.55,"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":407.48,"discounted_cash":244.49,"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":10.61,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.08,"discounted_cash":9.65,"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":11.48,"discounted_cash":6.89,"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":"0169-7215-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":6.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ANTIHEMOPHIL FACTOR (RAHF-PFM) 2000 UNITS IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0944-3045-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.07,"discounted_cash":0.04,"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":24.67,"discounted_cash":14.80,"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":24.67,"discounted_cash":14.80,"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":7.37,"discounted_cash":4.42,"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":"0562-7805-05","type":"NDC"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":243.6,"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":406.0,"discounted_cash":243.6,"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":406.0,"discounted_cash":243.6,"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":406.0,"discounted_cash":243.6,"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":166.89,"discounted_cash":100.13,"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":"76125-150-11","type":"NDC"}],"standard_charges":[{"gross_charge":1845.14,"discounted_cash":1107.09,"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":1844.66,"discounted_cash":1106.79,"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":"71288-433-91","type":"NDC"}],"standard_charges":[{"gross_charge":22.02,"discounted_cash":13.22,"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":17.55,"discounted_cash":10.53,"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":18.62,"discounted_cash":11.17,"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":13.74,"discounted_cash":8.24,"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":"71288-436-91","type":"NDC"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":9.32,"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":12.06,"discounted_cash":7.24,"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":11.67,"discounted_cash":7.00,"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":"71288-438-95","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":"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":84.28,"discounted_cash":50.57,"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":"69097-168-64","type":"NDC"}],"standard_charges":[{"gross_charge":78.15,"discounted_cash":46.89,"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":"72189-403-03","type":"NDC"}],"standard_charges":[{"gross_charge":320.5,"discounted_cash":192.3,"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":81.15,"discounted_cash":48.69,"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":3.49,"discounted_cash":2.10,"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":392.45,"discounted_cash":235.47,"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":"0636","type":"RC"},{"code":"73293-0001-1","type":"NDC"}],"standard_charges":[{"gross_charge":0.57,"discounted_cash":0.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EFGARTIGIMOD ALFA-FCAB 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"73475-3041-5","type":"NDC"}],"standard_charges":[{"gross_charge":167.27,"discounted_cash":100.36,"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":92.95,"discounted_cash":55.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":17.74,"discounted_cash":10.64,"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":1732.95,"discounted_cash":1039.77,"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":1765.12,"discounted_cash":1059.07,"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":"72205-264-25","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":"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":260.2,"discounted_cash":156.12,"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":"68982-643-01","type":"NDC"}],"standard_charges":[{"gross_charge":404.85,"discounted_cash":242.91,"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":"68462-897-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.79,"discounted_cash":6.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPARIN SOD (PORK) LOCK FLUSH 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-545-05","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":"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":244.67,"discounted_cash":146.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-593-03","type":"NDC"}],"standard_charges":[{"gross_charge":986.95,"discounted_cash":592.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-596-03","type":"NDC"}],"standard_charges":[{"gross_charge":1021.71,"discounted_cash":613.02,"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":107.02,"discounted_cash":64.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 200 MCG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-647-10","type":"NDC"}],"standard_charges":[{"gross_charge":53.28,"discounted_cash":31.97,"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":"63323-664-00","type":"NDC"}],"standard_charges":[{"gross_charge":85.04,"discounted_cash":51.02,"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":38.05,"discounted_cash":22.83,"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":37.85,"discounted_cash":22.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 10 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-695-04","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":"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":21.83,"discounted_cash":13.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":21.58,"discounted_cash":12.95,"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":"63323-729-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":1.56,"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":"63323-739-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.61,"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":0.93,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROMORPHONE HCL PF 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-852-25","type":"NDC"}],"standard_charges":[{"gross_charge":93.55,"discounted_cash":56.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.28,"discounted_cash":6.17,"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":49.12,"discounted_cash":29.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVOTHYROXINE SODIUM 200 MCG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-890-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.66,"discounted_cash":29.80,"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":"63323-530-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.88,"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":"63323-930-00","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":"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":6.84,"discounted_cash":4.10,"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":"63323-495-09","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":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-467-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.61,"discounted_cash":0.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLOROPROCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-477-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.39,"discounted_cash":0.23,"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":"63323-482-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.39,"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":0.47,"discounted_cash":0.28,"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":0.71,"discounted_cash":0.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-488-07","type":"NDC"}],"standard_charges":[{"gross_charge":117.76,"discounted_cash":70.66,"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":0.57,"discounted_cash":0.34,"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":"63323-489-02","type":"NDC"}],"standard_charges":[{"gross_charge":152.2,"discounted_cash":91.32,"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"},{"gross_charge":0.56,"discounted_cash":0.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-491-01","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":"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":2.37,"discounted_cash":1.42,"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":0.40,"discounted_cash":0.24,"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":2.28,"discounted_cash":1.37,"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":"63323-492-36","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":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"63323-492-43","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.91,"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":0.40,"discounted_cash":0.24,"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":0.50,"discounted_cash":0.30,"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":"63323-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"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":7.96,"discounted_cash":4.77,"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":5.20,"discounted_cash":3.12,"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":8.84,"discounted_cash":5.30,"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":11.06,"discounted_cash":6.63,"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":10223.76,"discounted_cash":6134.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.25 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-823-12","type":"NDC"}],"standard_charges":[{"gross_charge":49.70,"discounted_cash":29.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.41,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-824-15","type":"NDC"}],"standard_charges":[{"gross_charge":54.93,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.70,"discounted_cash":1.02,"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":10.25,"discounted_cash":6.15,"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":11.4,"discounted_cash":6.84,"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":"67919-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":2.37,"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":641.80,"discounted_cash":385.08,"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":6.57,"discounted_cash":3.94,"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":4.85,"discounted_cash":2.91,"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":8.29,"discounted_cash":4.97,"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":17.05,"discounted_cash":10.23,"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":19.6,"discounted_cash":11.76,"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":1.67,"discounted_cash":1.00,"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":"68462-157-40","type":"NDC"}],"standard_charges":[{"gross_charge":21.61,"discounted_cash":12.97,"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":25.87,"discounted_cash":15.52,"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":20.12,"discounted_cash":12.08,"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":0.93,"discounted_cash":0.56,"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":78.77,"discounted_cash":47.26,"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":13.73,"discounted_cash":8.24,"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":"63323-983-53","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":"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":11.11,"discounted_cash":6.67,"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":11.57,"discounted_cash":6.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHACHOLINE CHLORIDE 100 MG IN SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"64281-100-00","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":"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":137.78,"discounted_cash":82.67,"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":6.96,"discounted_cash":4.18,"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":5.12,"discounted_cash":3.07,"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":24.94,"discounted_cash":14.96,"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":26.35,"discounted_cash":15.81,"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":"68516-5214-9","type":"NDC"}],"standard_charges":[{"gross_charge":328.3,"discounted_cash":196.98,"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":"65282-1605-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.74,"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":0.45,"discounted_cash":0.27,"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":100.63,"discounted_cash":60.38,"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":"67457-153-00","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":"FOMEPIZOLE 1 GM/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"67457-211-02","type":"NDC"}],"standard_charges":[{"gross_charge":43.62,"discounted_cash":26.17,"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":90.65,"discounted_cash":54.39,"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":106.95,"discounted_cash":64.17,"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":"67457-340-00","type":"NDC"}],"standard_charges":[{"gross_charge":63.62,"discounted_cash":38.18,"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":"67457-349-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.05,"discounted_cash":37.23,"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":"67457-385-10","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":"ONDANSETRON 4 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"65862-390-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.31,"discounted_cash":12.79,"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":260.2,"discounted_cash":156.12,"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":3.42,"discounted_cash":2.05,"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":1.85,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":86.99,"discounted_cash":52.20,"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":44.51,"discounted_cash":26.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.03,"discounted_cash":0.62,"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":45.77,"discounted_cash":27.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.26,"discounted_cash":0.75,"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":1.02,"discounted_cash":0.61,"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":"0143-9330-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":1.16,"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":"0143-9330-10","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":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9331-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.84,"discounted_cash":0.50,"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":"0143-9331-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.67,"discounted_cash":0.40,"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":1.15,"discounted_cash":0.69,"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":"0143-9333-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.59,"discounted_cash":0.36,"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":"0143-9357-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.62,"discounted_cash":40.58,"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":9.79,"discounted_cash":5.87,"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":88.70,"discounted_cash":53.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 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":50.72,"discounted_cash":30.44,"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":"0143-9575-01","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":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9594-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.08,"discounted_cash":0.05,"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":"0143-9595-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.89,"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":21.48,"discounted_cash":12.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9153-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.93,"discounted_cash":32.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 3 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9140-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.27,"discounted_cash":10.96,"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":387.80,"discounted_cash":232.68,"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":"0636","type":"RC"},{"code":"0069-0291-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.02,"discounted_cash":1.81,"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":511.70,"discounted_cash":307.02,"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":47.12,"discounted_cash":28.28,"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":45.58,"discounted_cash":27.35,"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":"0069-6001-02","type":"NDC"}],"standard_charges":[{"gross_charge":89.4,"discounted_cash":53.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 500 MG PE/10ML 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":53.49,"discounted_cash":32.10,"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":11475.47,"discounted_cash":6885.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0074-3473-03","type":"NDC"}],"standard_charges":[{"gross_charge":11294.07,"discounted_cash":6776.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0074-3642-03","type":"NDC"}],"standard_charges":[{"gross_charge":11279.24,"discounted_cash":6767.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0074-3683-03","type":"NDC"}],"standard_charges":[{"gross_charge":11055.16,"discounted_cash":6633.10,"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":90.48,"discounted_cash":54.29,"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":"0075-0621-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.47,"discounted_cash":27.28,"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":"0075-0622-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.04,"discounted_cash":24.62,"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":"0075-0623-03","type":"NDC"}],"standard_charges":[{"gross_charge":39.49,"discounted_cash":23.70,"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":"0075-2915-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.61,"discounted_cash":8.76,"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":65.55,"discounted_cash":39.33,"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":24.9,"discounted_cash":14.94,"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":1.96,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CEFAZOLIN SODIUM 3 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0143-9140-25","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":11.03,"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":1.30,"discounted_cash":0.78,"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":55.88,"discounted_cash":33.53,"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":83.20,"discounted_cash":49.92,"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":92.65,"discounted_cash":55.59,"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":65.43,"discounted_cash":39.26,"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":64.93,"discounted_cash":38.96,"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":112.95,"discounted_cash":67.77,"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":217.25,"discounted_cash":130.35,"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":"0636","type":"RC"},{"code":"0338-9159-30","type":"NDC"}],"standard_charges":[{"gross_charge":171.38,"discounted_cash":102.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-9553-24","type":"NDC"}],"standard_charges":[{"gross_charge":64.93,"discounted_cash":38.96,"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":"0409-0007-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.56,"discounted_cash":0.34,"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":"0409-0007-10","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":"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":1.24,"discounted_cash":0.74,"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":"0409-1162-18","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":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1178-03","type":"NDC"}],"standard_charges":[{"gross_charge":102.29,"discounted_cash":61.37,"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":"0409-1178-30","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":"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":133.97,"discounted_cash":80.38,"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":83.87,"discounted_cash":50.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.42,"discounted_cash":7.45,"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":84.11,"discounted_cash":50.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.05,"discounted_cash":6.63,"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":"0409-1312-03","type":"NDC"}],"standard_charges":[{"gross_charge":85.58,"discounted_cash":51.34,"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":"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":83.13,"discounted_cash":49.88,"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":48.46,"discounted_cash":29.08,"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":151.25,"discounted_cash":90.75,"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":3.04,"discounted_cash":1.82,"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":196.1,"discounted_cash":117.66,"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":82.59,"discounted_cash":49.55,"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":11.15,"discounted_cash":6.69,"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":11.9,"discounted_cash":7.14,"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":22.96,"discounted_cash":13.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEPOLIZUMAB 100 MG SC SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0173-0881-01","type":"NDC"}],"standard_charges":[{"gross_charge":189.04,"discounted_cash":113.43,"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":1.25,"discounted_cash":0.75,"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":227.76,"discounted_cash":136.65,"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":614.95,"discounted_cash":368.97,"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":"0054-8740-25","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":"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":1035.86,"discounted_cash":621.52,"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":158.28,"discounted_cash":94.97,"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":162.12,"discounted_cash":97.27,"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":149.73,"discounted_cash":89.84,"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":"0636","type":"RC"},{"code":"0338-0049-48","type":"NDC"}],"standard_charges":[{"gross_charge":144.41,"discounted_cash":86.65,"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":0.62,"discounted_cash":0.37,"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":0.09,"discounted_cash":0.05,"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":19.93,"discounted_cash":11.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENICILLIN G POT IN DEXTROSE 60000 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0338-1025-41","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":"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":23.26,"discounted_cash":13.96,"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":156.69,"discounted_cash":94.02,"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":1.10,"discounted_cash":0.66,"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":"0054-0017-20","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":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"70756-612-60","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":47.1,"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":0.43,"discounted_cash":0.26,"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":"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":1.36,"discounted_cash":0.81,"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":37.5,"discounted_cash":22.5,"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":3.93,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":72.74,"discounted_cash":43.64,"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":1.73,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":32.51,"discounted_cash":19.50,"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":0.41,"discounted_cash":0.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.49,"discounted_cash":3.89,"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":84.4,"discounted_cash":50.64,"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":30.14,"discounted_cash":18.08,"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":16.06,"discounted_cash":9.63,"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":22.73,"discounted_cash":13.64,"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":21.0,"discounted_cash":12.6,"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":15.42,"discounted_cash":9.25,"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":29.32,"discounted_cash":17.59,"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":22.81,"discounted_cash":13.69,"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":"70756-612-44","type":"NDC"}],"standard_charges":[{"gross_charge":78.5,"discounted_cash":47.1,"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":20.13,"discounted_cash":12.08,"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":78.15,"discounted_cash":46.89,"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":"70594-119-01","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":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68982-623-02","type":"NDC"}],"standard_charges":[{"gross_charge":459.45,"discounted_cash":275.67,"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":"68982-643-01","type":"NDC"}],"standard_charges":[{"gross_charge":381.07,"discounted_cash":228.64,"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":"69097-168-64","type":"NDC"}],"standard_charges":[{"gross_charge":78.15,"discounted_cash":46.89,"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":"0250","type":"RC"},{"code":"69097-708-31","type":"NDC"}],"standard_charges":[{"gross_charge":25.77,"discounted_cash":15.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":26.30,"discounted_cash":15.78,"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":30.70,"discounted_cash":18.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":35.91,"discounted_cash":21.54,"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":"69680-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":94.2,"discounted_cash":56.52,"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":11.54,"discounted_cash":6.93,"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":93.89,"discounted_cash":56.33,"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":"70069-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.61,"discounted_cash":0.37,"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":27.15,"discounted_cash":16.29,"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":"70121-1577-1","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":"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":129.9,"discounted_cash":77.94,"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":225.4,"discounted_cash":135.24,"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":"70461-024-03","type":"NDC"}],"standard_charges":[{"gross_charge":354.75,"discounted_cash":212.85,"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":354.75,"discounted_cash":212.85,"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":"70515-260-10","type":"NDC"}],"standard_charges":[{"gross_charge":273.18,"discounted_cash":163.90,"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":14.75,"discounted_cash":8.85,"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":78.15,"discounted_cash":46.89,"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":18.58,"discounted_cash":11.15,"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":"71288-435-91","type":"NDC"}],"standard_charges":[{"gross_charge":22.02,"discounted_cash":13.22,"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":14.94,"discounted_cash":8.96,"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":20.96,"discounted_cash":12.58,"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":320.71,"discounted_cash":192.42,"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":1050.02,"discounted_cash":630.01,"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":93.69,"discounted_cash":56.21,"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":128.33,"discounted_cash":77.00,"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":12.88,"discounted_cash":7.73,"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":13.01,"discounted_cash":7.81,"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":5.48,"discounted_cash":3.29,"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":5.61,"discounted_cash":3.37,"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":1.25,"discounted_cash":0.75,"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":1.65,"discounted_cash":0.99,"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":1.48,"discounted_cash":0.89,"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":1.48,"discounted_cash":0.89,"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":91.5,"discounted_cash":54.9,"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":91.5,"discounted_cash":54.9,"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":76.64,"discounted_cash":45.98,"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":83.44,"discounted_cash":50.06,"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":13.75,"discounted_cash":8.25,"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":"0049-3920-20","type":"NDC"}],"standard_charges":[{"gross_charge":163.91,"discounted_cash":98.35,"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":1.78,"discounted_cash":1.07,"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":3.45,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-8215-17","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":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-8215-01","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":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"71288-436-91","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":10.88,"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":14.43,"discounted_cash":8.66,"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":10.56,"discounted_cash":6.34,"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":88.70,"discounted_cash":53.22,"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":"71288-808-75","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":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"72205-102-01","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":"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":3.60,"discounted_cash":2.16,"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":"0250","type":"RC"},{"code":"76045-009-96","type":"NDC"}],"standard_charges":[{"gross_charge":92.95,"discounted_cash":55.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":17.97,"discounted_cash":10.78,"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":0.71,"discounted_cash":0.42,"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":167.0,"discounted_cash":100.2,"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":1.36,"discounted_cash":0.82,"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":"76329-3369-1","type":"NDC"}],"standard_charges":[{"gross_charge":107.40,"discounted_cash":64.44,"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":1.07,"discounted_cash":0.64,"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":18.45,"discounted_cash":11.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INSULIN LISPRO SUB-Q DOSE CALCULATOR SCHEDULED ORDERABLE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0002-7510-01","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":"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":8.74,"discounted_cash":5.25,"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":6.51,"discounted_cash":3.91,"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":"0002-7597-01","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 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":5.65,"discounted_cash":3.39,"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":8.01,"discounted_cash":4.81,"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":10.42,"discounted_cash":6.25,"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":"0409-1312-30","type":"NDC"}],"standard_charges":[{"gross_charge":90.1,"discounted_cash":54.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.29,"discounted_cash":4.37,"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":14.54,"discounted_cash":8.72,"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":"0904-7141-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.98,"discounted_cash":8.99,"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":3.88,"discounted_cash":2.32,"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":"0944-0493-01","type":"NDC"}],"standard_charges":[{"gross_charge":335.6,"discounted_cash":201.36,"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":"0955-1003-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.7,"discounted_cash":20.22,"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":"0955-1004-10","type":"NDC"}],"standard_charges":[{"gross_charge":27.19,"discounted_cash":16.31,"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":"10019-075-87","type":"NDC"}],"standard_charges":[{"gross_charge":12.22,"discounted_cash":7.33,"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":183.8,"discounted_cash":110.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-636-03","type":"NDC"}],"standard_charges":[{"gross_charge":412.25,"discounted_cash":247.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"13533-636-50","type":"NDC"}],"standard_charges":[{"gross_charge":529.98,"discounted_cash":317.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"14789-128-05","type":"NDC"}],"standard_charges":[{"gross_charge":151.49,"discounted_cash":90.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"14789-128-07","type":"NDC"}],"standard_charges":[{"gross_charge":150.30,"discounted_cash":90.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"16729-277-30","type":"NDC"}],"standard_charges":[{"gross_charge":52.82,"discounted_cash":31.69,"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":1.85,"discounted_cash":1.11,"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":"17478-538-02","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":"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":1.93,"discounted_cash":1.16,"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":1.93,"discounted_cash":1.16,"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":148.55,"discounted_cash":89.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMIKACIN SULFATE 500 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"23155-290-31","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":"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":95.35,"discounted_cash":57.21,"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":"0904-7127-61","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":"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":196.58,"discounted_cash":117.95,"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":0.70,"discounted_cash":0.42,"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":"0904-6461-61","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":"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":77.98,"discounted_cash":46.79,"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":39.4,"discounted_cash":23.64,"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":55.24,"discounted_cash":33.15,"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":54.11,"discounted_cash":32.47,"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":47.84,"discounted_cash":28.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 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":55.8,"discounted_cash":33.48,"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":91.35,"discounted_cash":54.81,"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":9.74,"discounted_cash":5.84,"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":12.92,"discounted_cash":7.75,"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":34.37,"discounted_cash":20.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 250 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3402-78","type":"NDC"}],"standard_charges":[{"gross_charge":83.94,"discounted_cash":50.36,"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":86.56,"discounted_cash":51.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMPICILLIN SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3407-78","type":"NDC"}],"standard_charges":[{"gross_charge":81.55,"discounted_cash":48.93,"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":37.15,"discounted_cash":22.29,"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":"0781-3422-92","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":"COSYNTROPIN 0.25 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0781-3440-71","type":"NDC"}],"standard_charges":[{"gross_charge":381.05,"discounted_cash":228.63,"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":"0781-9105-72","type":"NDC"}],"standard_charges":[{"gross_charge":14.02,"discounted_cash":8.42,"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":32.06,"discounted_cash":19.24,"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":"0904-6623-61","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":"PROPOFOL 500 MG/50ML 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":5.15,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2.15,"discounted_cash":1.29,"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":19.91,"discounted_cash":11.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPOFOL 200 MG/20ML 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":4.48,"discounted_cash":2.69,"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":"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":1.89,"discounted_cash":1.13,"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":"MIDAZOLAM HCL 50 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-661-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.63,"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":70.53,"discounted_cash":42.32,"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":94.94,"discounted_cash":56.96,"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":348.16,"discounted_cash":208.90,"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":"36000-012-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":12.19,"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":8.70,"discounted_cash":5.22,"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":1.12,"discounted_cash":0.67,"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":20.41,"discounted_cash":12.25,"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":9.78,"discounted_cash":5.87,"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":8.06,"discounted_cash":4.84,"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":"39822-3030-1","type":"NDC"}],"standard_charges":[{"gross_charge":399.85,"discounted_cash":239.91,"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":399.85,"discounted_cash":239.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"39822-5525-2","type":"NDC"}],"standard_charges":[{"gross_charge":81.75,"discounted_cash":49.05,"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":55.09,"discounted_cash":33.06,"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":19.01,"discounted_cash":11.41,"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":39.49,"discounted_cash":23.70,"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":"25021-601-03","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":"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":87.85,"discounted_cash":52.71,"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":"25021-500-02","type":"NDC"}],"standard_charges":[{"gross_charge":56.9,"discounted_cash":34.14,"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":"23155-547-42","type":"NDC"}],"standard_charges":[{"gross_charge":19.91,"discounted_cash":11.95,"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":19.85,"discounted_cash":11.91,"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":"23155-600-31","type":"NDC"}],"standard_charges":[{"gross_charge":40.58,"discounted_cash":24.34,"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":7.41,"discounted_cash":4.45,"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":"25021-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.58,"discounted_cash":12.95,"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":"25021-109-10","type":"NDC"}],"standard_charges":[{"gross_charge":99.6,"discounted_cash":59.76,"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":"25021-110-20","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":"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":49.8,"discounted_cash":29.88,"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":"25021-132-83","type":"NDC"}],"standard_charges":[{"gross_charge":62.22,"discounted_cash":37.33,"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":111.75,"discounted_cash":67.05,"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":"25021-151-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.50,"discounted_cash":25.50,"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":"25021-184-87","type":"NDC"}],"standard_charges":[{"gross_charge":99.3,"discounted_cash":59.58,"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":7.85,"discounted_cash":4.71,"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":7.85,"discounted_cash":4.71,"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":"25021-301-67","type":"NDC"}],"standard_charges":[{"gross_charge":20.06,"discounted_cash":12.04,"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":"25021-311-10","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":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"25021-315-01","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":"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":16.6,"discounted_cash":9.96,"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":22.97,"discounted_cash":13.78,"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":15.75,"discounted_cash":9.45,"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":178.65,"discounted_cash":107.19,"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":1.23,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":117.27,"discounted_cash":70.36,"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":"0641-6182-25","type":"NDC"}],"standard_charges":[{"gross_charge":127.47,"discounted_cash":76.48,"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":"0409-4277-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.51,"discounted_cash":0.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.39,"discounted_cash":0.24,"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":"0409-4277-17","type":"NDC"}],"standard_charges":[{"gross_charge":0.21,"discounted_cash":0.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":0.28,"discounted_cash":0.17,"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":0.50,"discounted_cash":0.30,"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":0.48,"discounted_cash":0.29,"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":0.55,"discounted_cash":0.33,"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":52.80,"discounted_cash":31.68,"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":85.65,"discounted_cash":51.39,"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":"0409-4910-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.00,"discounted_cash":1.20,"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":"0409-5922-16","type":"NDC"}],"standard_charges":[{"gross_charge":60.05,"discounted_cash":36.03,"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":"0409-6653-18","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":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-6729-09","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.32,"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":"0409-7338-11","type":"NDC"}],"standard_charges":[{"gross_charge":40.75,"discounted_cash":24.45,"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":80.89,"discounted_cash":48.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-9094-16","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":"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":83.04,"discounted_cash":49.82,"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":"0456-0600-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.01,"discounted_cash":9.60,"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":394.92,"discounted_cash":236.96,"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":"0517-0031-01","type":"NDC"}],"standard_charges":[{"gross_charge":104.2,"discounted_cash":62.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-0381-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.44,"discounted_cash":37.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":32.47,"discounted_cash":19.48,"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":0.54,"discounted_cash":0.33,"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":"0636","type":"RC"},{"code":"0409-4264-11","type":"NDC"}],"standard_charges":[{"gross_charge":88.91,"discounted_cash":53.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.52,"discounted_cash":9.91,"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":91.84,"discounted_cash":55.11,"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":"0409-1560-18","type":"NDC"}],"standard_charges":[{"gross_charge":0.89,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1623-01","type":"NDC"}],"standard_charges":[{"gross_charge":105.48,"discounted_cash":63.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-1626-21","type":"NDC"}],"standard_charges":[{"gross_charge":94.3,"discounted_cash":56.58,"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":1.16,"discounted_cash":0.69,"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":86.86,"discounted_cash":52.12,"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":"0409-1890-13","type":"NDC"}],"standard_charges":[{"gross_charge":96.60,"discounted_cash":57.96,"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":"0409-2267-20","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":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-2305-04","type":"NDC"}],"standard_charges":[{"gross_charge":18.25,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.42,"discounted_cash":9.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-2305-05","type":"NDC"}],"standard_charges":[{"gross_charge":15.99,"discounted_cash":9.59,"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":7.44,"discounted_cash":4.46,"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":2.20,"discounted_cash":1.32,"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":"0409-3183-01","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":"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":82.15,"discounted_cash":49.29,"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":82.16,"discounted_cash":49.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANCOMYCIN HCL 1.5 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0409-3515-11","type":"NDC"}],"standard_charges":[{"gross_charge":55.22,"discounted_cash":33.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1.10,"discounted_cash":0.66,"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":"0409-3795-19","type":"NDC"}],"standard_charges":[{"gross_charge":89.75,"discounted_cash":53.85,"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":9.24,"discounted_cash":5.55,"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":36.62,"discounted_cash":21.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6020-10","type":"NDC"}],"standard_charges":[{"gross_charge":187.45,"discounted_cash":112.47,"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":84.20,"discounted_cash":50.52,"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":80.03,"discounted_cash":48.02,"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":"0641-6057-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.25,"discounted_cash":22.95,"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":40.22,"discounted_cash":24.13,"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":14.65,"discounted_cash":8.79,"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":"0641-6059-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.2,"discounted_cash":19.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6061-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.15,"discounted_cash":9.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6061-25","type":"NDC"}],"standard_charges":[{"gross_charge":17.88,"discounted_cash":10.73,"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":86.02,"discounted_cash":51.61,"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":86.24,"discounted_cash":51.75,"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":24.78,"discounted_cash":14.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":51.7,"discounted_cash":31.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6137-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.36,"discounted_cash":20.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6149-01","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":"AMIKACIN SULFATE 500 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6167-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.36,"discounted_cash":12.82,"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":"0641-6173-01","type":"NDC"}],"standard_charges":[{"gross_charge":165.25,"discounted_cash":99.15,"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":13.84,"discounted_cash":8.31,"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":125.80,"discounted_cash":75.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-6020-01","type":"NDC"}],"standard_charges":[{"gross_charge":187.45,"discounted_cash":112.47,"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":"0641-6008-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.92,"discounted_cash":14.96,"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":"0636","type":"RC"},{"code":"0641-1410-31","type":"NDC"}],"standard_charges":[{"gross_charge":88.94,"discounted_cash":53.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-0928-21","type":"NDC"}],"standard_charges":[{"gross_charge":83.55,"discounted_cash":50.13,"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":"0517-1001-25","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":"ATROPINE SULFATE (PF) 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-1010-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.74,"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":2.74,"discounted_cash":1.64,"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":2.25,"discounted_cash":1.35,"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":"0517-2340-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":1.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETYLCYSTEINE 10 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-7504-01","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":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-7604-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":19.56,"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":"0517-7604-25","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":"AMINOCAPROIC ACID 250 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0517-9120-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.48,"discounted_cash":10.49,"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":94.01,"discounted_cash":56.41,"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":2.67,"discounted_cash":1.6,"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":"0641-0367-21","type":"NDC"}],"standard_charges":[{"gross_charge":16.12,"discounted_cash":9.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.46,"discounted_cash":6.27,"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":9.14,"discounted_cash":5.48,"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":80.61,"discounted_cash":48.37,"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":80.95,"discounted_cash":48.57,"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":"0641-0476-21","type":"NDC"}],"standard_charges":[{"gross_charge":167.36,"discounted_cash":100.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-0477-21","type":"NDC"}],"standard_charges":[{"gross_charge":226.23,"discounted_cash":135.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0636","type":"RC"},{"code":"0641-0477-25","type":"NDC"}],"standard_charges":[{"gross_charge":193.85,"discounted_cash":116.31,"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":480.75,"discounted_cash":288.45,"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":"68084-655-11","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":"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":15.94,"discounted_cash":9.57,"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":12.02,"discounted_cash":7.21,"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":7.40,"discounted_cash":4.44,"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":5.94,"discounted_cash":3.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LEVETIRACETAM 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7125-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":4.63,"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":"0904-7126-61","type":"NDC"}],"standard_charges":[{"gross_charge":9.89,"discounted_cash":5.94,"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":9.35,"discounted_cash":5.61,"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":"0904-7168-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.2,"discounted_cash":14.52,"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":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.18,"discounted_cash":4.31,"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":7.74,"discounted_cash":4.64,"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":7.54,"discounted_cash":4.53,"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":8.2,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.39,"discounted_cash":4.43,"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":"0904-7188-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":13.37,"discounted_cash":8.02,"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":8.00,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.86,"discounted_cash":4.72,"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":7.95,"discounted_cash":4.77,"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":7.34,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LISINOPRIL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7200-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7121-61","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":"BISMUTH SUBSALICYLATE 262 MG PO CHEW","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7205-46","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":"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":8.60,"discounted_cash":5.16,"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":8.31,"discounted_cash":4.99,"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":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.88,"discounted_cash":4.73,"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":9.2,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.90,"discounted_cash":5.34,"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":8.72,"discounted_cash":5.23,"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":8.66,"discounted_cash":5.19,"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":"0904-6966-61","type":"NDC"}],"standard_charges":[{"gross_charge":8.38,"discounted_cash":5.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.27,"discounted_cash":4.36,"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":7.6,"discounted_cash":4.56,"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":"0904-6992-61","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":"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":8.22,"discounted_cash":4.93,"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":"0904-7000-61","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":"LAMOTRIGINE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7007-61","type":"NDC"}],"standard_charges":[{"gross_charge":5.51,"discounted_cash":3.31,"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":7.18,"discounted_cash":4.31,"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":11.55,"discounted_cash":6.93,"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":"0904-7044-61","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":"DULOXETINE HCL 60 MG PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7045-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.56,"discounted_cash":7.53,"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":"0904-7046-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.70,"discounted_cash":7.02,"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":8.80,"discounted_cash":5.28,"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":"0904-6872-04","type":"NDC"}],"standard_charges":[{"gross_charge":19.85,"discounted_cash":11.91,"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":8.55,"discounted_cash":5.13,"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":7.93,"discounted_cash":4.76,"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":"10019-553-90","type":"NDC"}],"standard_charges":[{"gross_charge":96.6,"discounted_cash":57.96,"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":73.5,"discounted_cash":44.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PORACTANT ALFA 120 MG/1.5ML INTRATRACHEA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10122-510-01","type":"NDC"}],"standard_charges":[{"gross_charge":2379.59,"discounted_cash":1427.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":2153.29,"discounted_cash":1291.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SORBITOL 70 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10135-137-08","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":"ITRACONAZOLE 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10147-0150-1","type":"NDC"}],"standard_charges":[{"gross_charge":168.9,"discounted_cash":101.34,"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":"10631-407-01","type":"NDC"}],"standard_charges":[{"gross_charge":338.25,"discounted_cash":202.95,"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":"10702-018-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.14,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRIAD HYDROPHILIC WOUND DRESS EX PSTE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"11701-031-33","type":"NDC"}],"standard_charges":[{"gross_charge":102.2,"discounted_cash":61.32,"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":27.17,"discounted_cash":16.30,"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":"12870-0001-2","type":"NDC"}],"standard_charges":[{"gross_charge":50.4,"discounted_cash":30.24,"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":"13107-001-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.8,"discounted_cash":9.48,"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":16.37,"discounted_cash":9.82,"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":13.99,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13668-094-90","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":"PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"13668-095-90","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":"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":110.33,"discounted_cash":66.20,"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":"14789-250-10","type":"NDC"}],"standard_charges":[{"gross_charge":185.21,"discounted_cash":111.13,"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":"16571-401-10","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":"SCOPOLAMINE 1 MG/3DAYS TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10019-553-04","type":"NDC"}],"standard_charges":[{"gross_charge":96.6,"discounted_cash":57.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 240 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7219-61","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":"OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"10006-70038","type":"NDC"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.42,"discounted_cash":3.85,"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":7.41,"discounted_cash":4.45,"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":"0904-7236-61","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":"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":6.75,"discounted_cash":4.05,"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":8.24,"discounted_cash":4.95,"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":6.97,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.79,"discounted_cash":4.07,"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":6.26,"discounted_cash":3.76,"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":15.72,"discounted_cash":9.43,"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":10.7,"discounted_cash":6.42,"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":11.8,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-7308-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":4.62,"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":5.22,"discounted_cash":3.13,"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":7.57,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IBUPROFEN 200 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":4.17,"discounted_cash":2.50,"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":"0904-8805-67","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"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":"0990-7990-09","type":"NDC"}],"standard_charges":[{"gross_charge":93.3,"discounted_cash":55.98,"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":7.8,"discounted_cash":4.68,"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":"0904-6868-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.83,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.30,"discounted_cash":4.38,"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":10.75,"discounted_cash":6.45,"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":"0904-6007-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.8,"discounted_cash":4.68,"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":"0904-6008-61","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":"ZOLPIDEM TARTRATE 2.5 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":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.36,"discounted_cash":3.81,"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":15.15,"discounted_cash":9.09,"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":13.45,"discounted_cash":8.07,"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":"0904-6172-61","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":"CARBIDOPA-LEVODOPA 12.5-50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6237-61","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":"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":8.03,"discounted_cash":4.82,"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":9.05,"discounted_cash":5.43,"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":6.36,"discounted_cash":3.82,"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":21.18,"discounted_cash":12.71,"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":"0904-6300-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.11,"discounted_cash":7.87,"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":14.13,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6303-61","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":"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":66.15,"discounted_cash":39.69,"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":93.35,"discounted_cash":56.01,"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":12.46,"discounted_cash":7.48,"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":12.14,"discounted_cash":7.29,"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":14.65,"discounted_cash":8.79,"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":5.62,"discounted_cash":3.37,"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":14.06,"discounted_cash":8.44,"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":"0904-0734-31","type":"NDC"}],"standard_charges":[{"gross_charge":57.9,"discounted_cash":34.74,"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":7.33,"discounted_cash":4.40,"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":7.65,"discounted_cash":4.59,"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":54.9,"discounted_cash":32.94,"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":8.00,"discounted_cash":4.80,"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":47.6,"discounted_cash":28.56,"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":7.6,"discounted_cash":4.56,"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":11.10,"discounted_cash":6.66,"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":7.65,"discounted_cash":4.59,"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":"0904-5522-61","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":"DOXAZOSIN MESYLATE 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5523-61","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":"DOXAZOSIN MESYLATE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-5524-61","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":"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":14.68,"discounted_cash":8.81,"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":15.15,"discounted_cash":9.09,"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":12.45,"discounted_cash":7.47,"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":11.34,"discounted_cash":6.81,"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":8.13,"discounted_cash":4.88,"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":8.45,"discounted_cash":5.07,"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":8.75,"discounted_cash":5.25,"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":"0904-5922-61","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":"TAMSULOSIN HCL 0.4 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6401-61","type":"NDC"}],"standard_charges":[{"gross_charge":20.48,"discounted_cash":12.29,"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":4.20,"discounted_cash":2.52,"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":4.45,"discounted_cash":2.67,"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":5.66,"discounted_cash":3.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.6,"discounted_cash":5.16,"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":4.84,"discounted_cash":2.90,"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":"0904-6663-61","type":"NDC"}],"standard_charges":[{"gross_charge":21.2,"discounted_cash":12.72,"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":6.67,"discounted_cash":4.00,"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":6.40,"discounted_cash":3.84,"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":5.94,"discounted_cash":3.56,"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":"0904-6705-61","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":6.81,"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":10.20,"discounted_cash":6.12,"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":"0904-6751-80","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":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6761-30","type":"NDC"}],"standard_charges":[{"gross_charge":48.15,"discounted_cash":28.89,"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":0.07,"discounted_cash":0.04,"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":"0904-6790-61","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":"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":0.10,"discounted_cash":0.06,"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":7.04,"discounted_cash":4.22,"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":5.58,"discounted_cash":3.35,"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":7.32,"discounted_cash":4.39,"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":"0904-6808-06","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":"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":8.75,"discounted_cash":5.25,"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":9.53,"discounted_cash":5.72,"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":7.69,"discounted_cash":4.61,"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":5.35,"discounted_cash":3.21,"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":8.04,"discounted_cash":4.82,"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":"0904-6418-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.44,"discounted_cash":7.46,"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":18.69,"discounted_cash":11.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":20.65,"discounted_cash":12.39,"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":12.28,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.64,"discounted_cash":7.59,"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":12.52,"discounted_cash":7.51,"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":9.05,"discounted_cash":5.43,"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":"0904-6477-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.01,"discounted_cash":4.21,"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":"16571-673-01","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":"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":68.1,"discounted_cash":40.86,"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":10.5,"discounted_cash":6.3,"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":"0904-6506-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"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":"0904-6510-06","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":"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":15.06,"discounted_cash":9.03,"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":"0904-6522-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.02,"discounted_cash":4.21,"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":"METHADONE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6530-61","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":"MORPHINE SULFATE ER 15 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6557-61","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":"VALACYCLOVIR HCL 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-6565-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.47,"discounted_cash":8.68,"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":9.26,"discounted_cash":5.56,"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":"16729-171-01","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":"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":1.85,"discounted_cash":1.11,"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":"16729-239-93","type":"NDC"}],"standard_charges":[{"gross_charge":142.36,"discounted_cash":85.42,"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":943.15,"discounted_cash":565.89,"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":33.95,"discounted_cash":20.37,"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":132.15,"discounted_cash":79.29,"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":15.39,"discounted_cash":9.23,"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":"43598-561-78","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":37.5,"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":62.5,"discounted_cash":37.5,"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":18.61,"discounted_cash":11.17,"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":34.09,"discounted_cash":20.45,"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":"43598-698-11","type":"NDC"}],"standard_charges":[{"gross_charge":1283.4,"discounted_cash":770.04,"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":9.04,"discounted_cash":5.42,"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":54.51,"discounted_cash":32.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VANICREAM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45334-300-04","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-004-02","type":"NDC"}],"standard_charges":[{"gross_charge":63.1,"discounted_cash":37.86,"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":"45802-056-11","type":"NDC"}],"standard_charges":[{"gross_charge":215.86,"discounted_cash":129.52,"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":58.87,"discounted_cash":35.32,"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":81.25,"discounted_cash":48.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-139-70","type":"NDC"}],"standard_charges":[{"gross_charge":556.3,"discounted_cash":333.78,"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":"45802-143-03","type":"NDC"}],"standard_charges":[{"gross_charge":67.1,"discounted_cash":40.26,"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":10.3,"discounted_cash":6.18,"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":"43598-210-40","type":"NDC"}],"standard_charges":[{"gross_charge":259.3,"discounted_cash":155.58,"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":"45802-160-00","type":"NDC"}],"standard_charges":[{"gross_charge":107.5,"discounted_cash":64.5,"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":11.15,"discounted_cash":6.69,"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":12.1,"discounted_cash":7.26,"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":"42292-040-01","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":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42494-301-00","type":"NDC"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":42.48,"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":114.58,"discounted_cash":68.75,"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":"42571-141-26","type":"NDC"}],"standard_charges":[{"gross_charge":269.95,"discounted_cash":161.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42571-147-26","type":"NDC"}],"standard_charges":[{"gross_charge":453.7,"discounted_cash":272.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RUFINAMIDE 400 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42571-392-12","type":"NDC"}],"standard_charges":[{"gross_charge":101.93,"discounted_cash":61.16,"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":10.95,"discounted_cash":6.57,"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":18.83,"discounted_cash":11.30,"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":"42799-920-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.85,"discounted_cash":18.51,"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":1.75,"discounted_cash":1.05,"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":"42806-266-98","type":"NDC"}],"standard_charges":[{"gross_charge":18.1,"discounted_cash":10.86,"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":9.45,"discounted_cash":5.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXYCODONE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"42858-002-01","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":"HYDROMORPHONE HCL 2 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":3.83,"discounted_cash":2.30,"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":"43386-090-19","type":"NDC"}],"standard_charges":[{"gross_charge":152.81,"discounted_cash":91.69,"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":"43386-161-01","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":"SOTALOL HCL 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-654-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.85,"discounted_cash":8.91,"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":"43547-280-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.35,"discounted_cash":12.81,"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":11.05,"discounted_cash":6.63,"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":60.3,"discounted_cash":36.18,"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":"45802-432-62","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":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"45802-434-11","type":"NDC"}],"standard_charges":[{"gross_charge":61.83,"discounted_cash":37.10,"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":"47781-426-11","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":"FENTANYL 75 MCG/HR TD PT72","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47781-427-47","type":"NDC"}],"standard_charges":[{"gross_charge":214.35,"discounted_cash":128.61,"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":"47781-468-13","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":34.17,"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":61.4,"discounted_cash":36.84,"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":14.44,"discounted_cash":8.66,"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":"48433-220-10","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":"TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49281-752-21","type":"NDC"}],"standard_charges":[{"gross_charge":117.7,"discounted_cash":70.62,"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":5.06,"discounted_cash":3.04,"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":"49884-465-65","type":"NDC"}],"standard_charges":[{"gross_charge":18.15,"discounted_cash":10.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEGESTROL ACETATE 400 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"49884-907-61","type":"NDC"}],"standard_charges":[{"gross_charge":17.75,"discounted_cash":10.65,"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":"50090-0183-0","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":3.16,"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":8.8,"discounted_cash":5.28,"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":13.45,"discounted_cash":8.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE 7 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50190-141-23","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":"HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50228-146-01","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":"CARBIDOPA-LEVODOPA 10-100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50228-457-01","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":"NABUMETONE 500 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50228-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":6.84,"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":553.33,"discounted_cash":332.00,"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":550.62,"discounted_cash":330.37,"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":78.3,"discounted_cash":46.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47781-358-11","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":40.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"47781-358-03","type":"NDC"}],"standard_charges":[{"gross_charge":68.8,"discounted_cash":41.28,"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":181.68,"discounted_cash":109.00,"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":"45802-438-03","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":"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":74.65,"discounted_cash":44.79,"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":8.80,"discounted_cash":5.28,"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":6.60,"discounted_cash":3.96,"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":131.3,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5ML PO SUER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"46122-141-21","type":"NDC"}],"standard_charges":[{"gross_charge":9.62,"discounted_cash":5.78,"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":69.1,"discounted_cash":41.46,"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":"46122-352-74","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":"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":74.15,"discounted_cash":44.49,"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":26.86,"discounted_cash":16.12,"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":7.95,"discounted_cash":4.77,"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":71.65,"discounted_cash":42.99,"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":"46122-690-78","type":"NDC"}],"standard_charges":[{"gross_charge":7.48,"discounted_cash":4.48,"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":"46122-703-26","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":"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":16.93,"discounted_cash":10.16,"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":47.82,"discounted_cash":28.69,"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":97.5,"discounted_cash":58.5,"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":74.34,"discounted_cash":44.60,"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":112.67,"discounted_cash":67.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":112.21,"discounted_cash":67.33,"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":78.0,"discounted_cash":46.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASCORBIC ACID 500 MG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0904-0523-61","type":"NDC"}],"standard_charges":[{"gross_charge":6.54,"discounted_cash":3.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.29,"discounted_cash":4.37,"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":"42192-608-06","type":"NDC"}],"standard_charges":[{"gross_charge":28.76,"discounted_cash":17.25,"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":175.19,"discounted_cash":105.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-486-10","type":"NDC"}],"standard_charges":[{"gross_charge":272.25,"discounted_cash":163.35,"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":"24208-580-60","type":"NDC"}],"standard_charges":[{"gross_charge":190.25,"discounted_cash":114.15,"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":"24208-601-10","type":"NDC"}],"standard_charges":[{"gross_charge":82.05,"discounted_cash":49.23,"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":382.75,"discounted_cash":229.65,"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":382.75,"discounted_cash":229.65,"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":187.75,"discounted_cash":112.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-790-62","type":"NDC"}],"standard_charges":[{"gross_charge":251.5,"discounted_cash":150.9,"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":113.7,"discounted_cash":68.22,"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":88.90,"discounted_cash":53.34,"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":60.73,"discounted_cash":36.44,"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":7.12,"discounted_cash":4.27,"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":8.55,"discounted_cash":5.13,"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":2.58,"discounted_cash":1.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAFFEINE CITRATE 20 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"25021-602-03","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":16.2,"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":20.33,"discounted_cash":12.20,"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":12.45,"discounted_cash":7.47,"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":32.35,"discounted_cash":19.41,"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":6.70,"discounted_cash":4.02,"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":200.35,"discounted_cash":120.21,"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":10.0,"discounted_cash":6.0,"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":128.75,"discounted_cash":77.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTAMIDINE ISETHIONATE 300 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"23155-748-31","type":"NDC"}],"standard_charges":[{"gross_charge":262.02,"discounted_cash":157.22,"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":13.8,"discounted_cash":8.28,"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":68.83,"discounted_cash":41.30,"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":"17238-424-06","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":"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":7.93,"discounted_cash":4.76,"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":7.72,"discounted_cash":4.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUORESCEIN SODIUM 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"17478-253-10","type":"NDC"}],"standard_charges":[{"gross_charge":350.1,"discounted_cash":210.06,"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":"17478-404-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":4.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ASCORBIC ACID 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-00100","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":"VITAMIN D3 25 MCG (1000 UT) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"20555-03300","type":"NDC"}],"standard_charges":[{"gross_charge":3.70,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":3.34,"discounted_cash":2.00,"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":4.34,"discounted_cash":2.61,"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":4.49,"discounted_cash":2.69,"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":8.2,"discounted_cash":4.92,"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":"21922-016-04","type":"NDC"}],"standard_charges":[{"gross_charge":474.5,"discounted_cash":284.7,"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":440.45,"discounted_cash":264.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"21922-039-23","type":"NDC"}],"standard_charges":[{"gross_charge":556.3,"discounted_cash":333.78,"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":89.41,"discounted_cash":53.65,"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":"23155-246-01","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":"POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"24208-315-10","type":"NDC"}],"standard_charges":[{"gross_charge":92.35,"discounted_cash":55.41,"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":13.14,"discounted_cash":7.88,"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":17.26,"discounted_cash":10.36,"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":14.60,"discounted_cash":8.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIOGLITAZONE HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-055-07","type":"NDC"}],"standard_charges":[{"gross_charge":44.8,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PIOGLITAZONE HCL 30 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"33342-055-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.8,"discounted_cash":26.88,"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":"35573-428-51","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":"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":81.73,"discounted_cash":49.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":20.79,"discounted_cash":12.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORA-BLEND SF PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"38779-2348-8","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":"HYDROCORTISONE ACETATE 25 MG RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-029-24","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":8.52,"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":107.42,"discounted_cash":64.46,"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":105.85,"discounted_cash":63.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":109.0,"discounted_cash":65.4,"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":105.85,"discounted_cash":63.51,"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":7.68,"discounted_cash":4.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.80,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"39328-120-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":14.91,"discounted_cash":8.95,"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":7.60,"discounted_cash":4.56,"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":"42023-115-10","type":"NDC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":72.0,"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":28.03,"discounted_cash":16.82,"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":"33255-10656","type":"NDC"}],"standard_charges":[{"gross_charge":59.55,"discounted_cash":35.73,"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":"31722-937-47","type":"NDC"}],"standard_charges":[{"gross_charge":8.00,"discounted_cash":4.80,"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":24.44,"discounted_cash":14.66,"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":"27241-167-01","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":"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":5.56,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROMETHAZINE-CODEINE 6.25-10 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"27808-065-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.55,"discounted_cash":5.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.33,"discounted_cash":5.00,"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":19.15,"discounted_cash":11.49,"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":35.85,"discounted_cash":21.51,"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":26.95,"discounted_cash":16.17,"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":"29300-126-13","type":"NDC"}],"standard_charges":[{"gross_charge":11.30,"discounted_cash":6.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BISOPROLOL FUMARATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"29300-127-13","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":"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":10.15,"discounted_cash":6.09,"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":"29300-413-01","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":"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":"31722-130-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.32,"discounted_cash":8.59,"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":"31722-203-20","type":"NDC"}],"standard_charges":[{"gross_charge":375.1,"discounted_cash":225.06,"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":7.83,"discounted_cash":4.70,"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":"31722-623-30","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":36.0,"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":"31722-630-31","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":34.17,"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":61.55,"discounted_cash":36.93,"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":"31722-702-90","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":10.32,"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":29.18,"discounted_cash":17.50,"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":"31722-722-50","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":44.85,"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":7.27,"discounted_cash":4.36,"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":10.98,"discounted_cash":6.59,"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":7.45,"discounted_cash":4.47,"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":13.8,"discounted_cash":8.28,"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":14.25,"discounted_cash":8.55,"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":18.45,"discounted_cash":11.07,"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":14.21,"discounted_cash":8.53,"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":83.88,"discounted_cash":50.32,"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":85.48,"discounted_cash":51.28,"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":"0143-9594-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.95,"discounted_cash":20.37,"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":"0143-9595-25","type":"NDC"}],"standard_charges":[{"gross_charge":59.46,"discounted_cash":35.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0143-9633-01","type":"NDC"}],"standard_charges":[{"gross_charge":885.45,"discounted_cash":531.27,"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":99.92,"discounted_cash":59.95,"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":103.81,"discounted_cash":62.29,"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":"0143-9786-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.05,"discounted_cash":57.03,"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":"0143-9787-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.1,"discounted_cash":58.26,"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":"0143-9873-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.95,"discounted_cash":47.97,"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":10.03,"discounted_cash":6.02,"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":"0168-0002-15","type":"NDC"}],"standard_charges":[{"gross_charge":84.55,"discounted_cash":50.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BETAMETHASONE VALERATE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0168-0040-15","type":"NDC"}],"standard_charges":[{"gross_charge":140.7,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN (LIQUID) 2.8 G RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0132-0190-12","type":"NDC"}],"standard_charges":[{"gross_charge":8.14,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0168-0080-31","type":"NDC"}],"standard_charges":[{"gross_charge":84.25,"discounted_cash":50.55,"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":7.95,"discounted_cash":4.77,"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":32.79,"discounted_cash":19.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEGESTROL ACETATE 400 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-0945-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":21.56,"discounted_cash":12.93,"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":"0121-0947-05","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":9.84,"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":14.20,"discounted_cash":8.52,"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":"0121-0974-10","type":"NDC"}],"standard_charges":[{"gross_charge":45.15,"discounted_cash":27.09,"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":12.15,"discounted_cash":7.29,"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":"0121-1190-30","type":"NDC"}],"standard_charges":[{"gross_charge":28.79,"discounted_cash":17.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0121-1276-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.32,"discounted_cash":8.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUAIFENESIN-DM 100-10 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":14.86,"discounted_cash":8.92,"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":11.99,"discounted_cash":7.19,"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":24.45,"discounted_cash":14.67,"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":16.28,"discounted_cash":9.77,"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":7.34,"discounted_cash":4.40,"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":"0121-1828-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.60,"discounted_cash":5.16,"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":"0121-1870-10","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":9.12,"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":15.06,"discounted_cash":9.04,"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":"0121-2044-10","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":"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":22.44,"discounted_cash":13.46,"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":8.90,"discounted_cash":5.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.00,"discounted_cash":5.40,"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":"0131-1810-67","type":"NDC"}],"standard_charges":[{"gross_charge":452.4,"discounted_cash":271.44,"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":"0168-0099-30","type":"NDC"}],"standard_charges":[{"gross_charge":221.05,"discounted_cash":132.63,"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":"0168-0258-15","type":"NDC"}],"standard_charges":[{"gross_charge":114.95,"discounted_cash":68.97,"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":192.6,"discounted_cash":115.56,"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":14.31,"discounted_cash":8.58,"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":87.36,"discounted_cash":52.41,"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":118.70,"discounted_cash":71.22,"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":"0310-1110-30","type":"NDC"}],"standard_charges":[{"gross_charge":119.72,"discounted_cash":71.84,"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":"0310-1110-39","type":"NDC"}],"standard_charges":[{"gross_charge":121.95,"discounted_cash":73.17,"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":27.63,"discounted_cash":16.58,"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":74.52,"discounted_cash":44.71,"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":70.28,"discounted_cash":42.17,"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":158.55,"discounted_cash":95.13,"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":"0338-0013-04","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":57.6,"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":159.35,"discounted_cash":95.61,"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":160.99,"discounted_cash":96.59,"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":275.36,"discounted_cash":165.22,"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":282.5,"discounted_cash":169.5,"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":166.45,"discounted_cash":99.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TPN ADULT SMMC WITHOUT ELECTROLYTES PERIPHERAL LINE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1133-03","type":"NDC"}],"standard_charges":[{"gross_charge":1416.9,"discounted_cash":850.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TPN ADULT SMMC WITH ELECTROLYTES CENTRAL LINE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0338-1148-03","type":"NDC"}],"standard_charges":[{"gross_charge":1416.9,"discounted_cash":850.14,"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":252.00,"discounted_cash":151.20,"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":11.86,"discounted_cash":7.12,"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":"0264-9376-88","type":"NDC"}],"standard_charges":[{"gross_charge":58.15,"discounted_cash":34.89,"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":162.99,"discounted_cash":97.79,"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":151.97,"discounted_cash":91.18,"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":153.8,"discounted_cash":92.28,"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":"0173-0682-24","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":"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":9.19,"discounted_cash":5.52,"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":21.14,"discounted_cash":12.68,"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":66.87,"discounted_cash":40.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TICAGRELOR 90 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":36.15,"discounted_cash":21.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AYR SALINE NASAL NA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0225-0525-47","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":"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":60.75,"discounted_cash":36.45,"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":8.45,"discounted_cash":5.07,"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":9.76,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ALPRAZOLAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2031-10","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":"PROPRANOLOL HCL ER 60 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0228-2778-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":8.4,"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":34.3,"discounted_cash":20.58,"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":"0234-0575-08","type":"NDC"}],"standard_charges":[{"gross_charge":53.12,"discounted_cash":31.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOTALOL HCL 120 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-0013-89","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":10.87,"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":30.98,"discounted_cash":18.59,"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":32.65,"discounted_cash":19.59,"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":"0245-0212-89","type":"NDC"}],"standard_charges":[{"gross_charge":17.98,"discounted_cash":10.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0245-0860-70","type":"NDC"}],"standard_charges":[{"gross_charge":590.3,"discounted_cash":354.18,"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":4.83,"discounted_cash":2.90,"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":10.15,"discounted_cash":6.09,"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":"0378-6982-32","type":"NDC"}],"standard_charges":[{"gross_charge":62.5,"discounted_cash":37.5,"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":23.75,"discounted_cash":14.25,"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":15.65,"discounted_cash":9.39,"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":366.2,"discounted_cash":219.72,"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":"0054-0220-20","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":"MORPHINE SULFATE 15 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":9.88,"discounted_cash":5.93,"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":"0054-0517-44","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":5.28,"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":"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":3.09,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.08,"discounted_cash":3.65,"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":8.85,"discounted_cash":5.31,"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":3.47,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DIAZEPAM 1 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-3188-63","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":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-3194-46","type":"NDC"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":19.14,"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":"0054-3270-99","type":"NDC"}],"standard_charges":[{"gross_charge":358.25,"discounted_cash":214.95,"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":"0054-3294-46","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":"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":10.20,"discounted_cash":6.12,"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":17.65,"discounted_cash":10.59,"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":"0054-4297-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.85,"discounted_cash":5.31,"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":8.34,"discounted_cash":5.00,"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":9.35,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0054-8301-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.45,"discounted_cash":7.47,"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":"0054-0011-20","type":"NDC"}],"standard_charges":[{"gross_charge":18.85,"discounted_cash":11.31,"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":8.05,"discounted_cash":4.83,"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":13.9,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 36000-114000 UNITS PO CPEP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0032-3016-13","type":"NDC"}],"standard_charges":[{"gross_charge":58.58,"discounted_cash":35.15,"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":"0003-0830-50","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":"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":49.22,"discounted_cash":29.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"APIXABAN 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":48.78,"discounted_cash":29.27,"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":146.75,"discounted_cash":88.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LOSARTAN POTASSIUM-HCTZ 50-12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0006-0717-31","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":"VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0006-4827-00","type":"NDC"}],"standard_charges":[{"gross_charge":769.05,"discounted_cash":461.43,"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":769.05,"discounted_cash":461.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":746.34,"discounted_cash":447.81,"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":579.47,"discounted_cash":347.68,"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":81.9,"discounted_cash":49.14,"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":"0023-0667-04","type":"NDC"}],"standard_charges":[{"gross_charge":81.9,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"UBROGEPANT 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0023-6501-02","type":"NDC"}],"standard_charges":[{"gross_charge":419.35,"discounted_cash":251.61,"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":11.75,"discounted_cash":7.05,"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":20.05,"discounted_cash":12.03,"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":10.71,"discounted_cash":6.43,"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":19.69,"discounted_cash":11.82,"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":24.3,"discounted_cash":14.58,"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":7.71,"discounted_cash":4.63,"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":48.63,"discounted_cash":29.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0426-36","type":"NDC"}],"standard_charges":[{"gross_charge":72.75,"discounted_cash":43.65,"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":"0093-3147-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.16,"discounted_cash":6.70,"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":4.53,"discounted_cash":2.72,"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":9.23,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-3541-43","type":"NDC"}],"standard_charges":[{"gross_charge":75.7,"discounted_cash":45.42,"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":7.58,"discounted_cash":4.55,"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":"0093-4177-73","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":9.63,"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":186.05,"discounted_cash":111.63,"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":21.5,"discounted_cash":12.9,"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":"0093-7536-56","type":"NDC"}],"standard_charges":[{"gross_charge":54.55,"discounted_cash":32.73,"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":"0093-8675-78","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":"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":9.98,"discounted_cash":5.99,"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":48.85,"discounted_cash":29.31,"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":15.25,"discounted_cash":9.15,"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":"0121-0489-05","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":11.56,"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":"0121-0530-05","type":"NDC"}],"standard_charges":[{"gross_charge":21.65,"discounted_cash":12.99,"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":"0121-0544-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":7.02,"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":11.18,"discounted_cash":6.71,"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":10.09,"discounted_cash":6.05,"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":116.65,"discounted_cash":69.99,"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":"0093-2275-34","type":"NDC"}],"standard_charges":[{"gross_charge":23.5,"discounted_cash":14.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN 875 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-2264-01","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":"AZITHROMYCIN 200 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-2026-23","type":"NDC"}],"standard_charges":[{"gross_charge":9.83,"discounted_cash":5.90,"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":8.45,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EYE STREAM OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0065-0530-01","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":"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":74.0,"discounted_cash":44.4,"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":"0069-5317-20","type":"NDC"}],"standard_charges":[{"gross_charge":5850.25,"discounted_cash":3510.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RISANKIZUMAB-RZAA 360 MG/2.4ML SC SOCT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0074-1070-01","type":"NDC"}],"standard_charges":[{"gross_charge":120922.0,"discounted_cash":72553.2,"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":"0074-4380-10","type":"NDC"}],"standard_charges":[{"gross_charge":152.25,"discounted_cash":91.35,"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":"0074-4382-20","type":"NDC"}],"standard_charges":[{"gross_charge":1161.3,"discounted_cash":696.78,"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":"0078-0249-15","type":"NDC"}],"standard_charges":[{"gross_charge":121.15,"discounted_cash":72.69,"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":55.99,"discounted_cash":33.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":55.81,"discounted_cash":33.48,"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":"0121-0893-15","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":"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":54.42,"discounted_cash":32.65,"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":"0085-4334-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.96,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLY-VI-SOL PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0087-0402-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLY-VI-SOL/IRON 11 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0087-0405-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":4.71,"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":0.63,"discounted_cash":0.38,"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":"0093-0771-98","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":"SOTALOL HCL 120 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0093-1060-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.42,"discounted_cash":9.85,"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":"0093-1061-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.9,"discounted_cash":8.94,"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":1166.15,"discounted_cash":699.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-043-15","type":"NDC"}],"standard_charges":[{"gross_charge":72.75,"discounted_cash":43.65,"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":"0378-6997-89","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":"RIVASTIGMINE 9.5 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0378-9071-16","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":"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":8.45,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MEDROXYPROGESTERONE ACETATE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0555-0873-02","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":"DERMABASE EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0071-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.6,"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":3.33,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORA-BLEND SF 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":10.45,"discounted_cash":6.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FERROUS GLUCONATE 324 (38 FE) MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0574-0508-11","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":"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":199.1,"discounted_cash":119.46,"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":12.1,"discounted_cash":7.26,"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":8.8,"discounted_cash":5.28,"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":51.35,"discounted_cash":30.81,"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":5.65,"discounted_cash":3.39,"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":9.65,"discounted_cash":5.79,"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":7.32,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GUANFACINE HCL 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-0444-01","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":"TAMOXIFEN CITRATE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-2472-60","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":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0591-3369-01","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":"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":123.0,"discounted_cash":73.8,"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":202.0,"discounted_cash":121.2,"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":10.75,"discounted_cash":6.45,"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":"0591-3510-54","type":"NDC"}],"standard_charges":[{"gross_charge":277.3,"discounted_cash":166.38,"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":8.17,"discounted_cash":4.90,"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":"0555-0071-02","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":"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":66.25,"discounted_cash":39.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POLYETHYL GLYCOL-PROPYL GLYCOL 0.4-0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1219-94","type":"NDC"}],"standard_charges":[{"gross_charge":49.15,"discounted_cash":29.49,"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":"0536-1228-58","type":"NDC"}],"standard_charges":[{"gross_charge":47.72,"discounted_cash":28.63,"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":"0536-1232-01","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":"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":5.00,"discounted_cash":3.00,"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":"0536-1248-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":3.24,"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":89.95,"discounted_cash":53.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-1254-94","type":"NDC"}],"standard_charges":[{"gross_charge":64.3,"discounted_cash":38.58,"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":53.62,"discounted_cash":32.18,"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":57.0,"discounted_cash":34.2,"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":8.01,"discounted_cash":4.81,"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":67.5,"discounted_cash":40.5,"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":68.0,"discounted_cash":40.8,"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":79.15,"discounted_cash":47.49,"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":8.7,"discounted_cash":5.22,"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":"0536-3030-25","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":"PRENATAL 28-0.8 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0536-4085-01","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":"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":12.95,"discounted_cash":7.77,"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":8.75,"discounted_cash":5.25,"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":8.6,"discounted_cash":5.16,"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":"0591-3875-45","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":"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":43.02,"discounted_cash":25.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0087-17","type":"NDC"}],"standard_charges":[{"gross_charge":25.6,"discounted_cash":15.36,"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":23.20,"discounted_cash":13.92,"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":"0781-7296-85","type":"NDC"}],"standard_charges":[{"gross_charge":2.92,"discounted_cash":1.75,"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":66.4,"discounted_cash":39.84,"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":"0781-8016-01","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":"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":26.83,"discounted_cash":16.10,"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":7.94,"discounted_cash":4.76,"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":10.35,"discounted_cash":6.21,"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":13.8,"discounted_cash":8.28,"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":14.94,"discounted_cash":8.96,"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":"0832-0542-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.60,"discounted_cash":9.96,"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":"0832-0585-25","type":"NDC"}],"standard_charges":[{"gross_charge":100.95,"discounted_cash":60.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 0.5 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":9.4,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.16,"discounted_cash":3.70,"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":8.99,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 2.5 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":9.55,"discounted_cash":5.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"WARFARIN SODIUM 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0832-1215-89","type":"NDC"}],"standard_charges":[{"gross_charge":8.49,"discounted_cash":5.09,"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":8.64,"discounted_cash":5.18,"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":"0832-1520-89","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":2.91,"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":10.48,"discounted_cash":6.29,"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":110.68,"discounted_cash":66.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3040-95","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":"PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0781-3040-72","type":"NDC"}],"standard_charges":[{"gross_charge":126.43,"discounted_cash":75.86,"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":6.37,"discounted_cash":3.82,"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":16.99,"discounted_cash":10.20,"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":80.75,"discounted_cash":48.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMPAGLIFLOZIN 5 MG PO TAB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0152-30","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":55.65,"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":93.79,"discounted_cash":56.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"EMPAGLIFLOZIN 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0597-0153-30","type":"NDC"}],"standard_charges":[{"gross_charge":92.75,"discounted_cash":55.65,"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":51.93,"discounted_cash":31.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":93.73,"discounted_cash":56.24,"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":66.97,"discounted_cash":40.18,"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":11.57,"discounted_cash":6.94,"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":12.03,"discounted_cash":7.22,"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":20.05,"discounted_cash":12.03,"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":"0641-6013-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.10,"discounted_cash":26.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0641-6014-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.22,"discounted_cash":53.54,"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":179.05,"discounted_cash":107.43,"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":"0703-9503-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.82,"discounted_cash":28.69,"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":"0713-0503-06","type":"NDC"}],"standard_charges":[{"gross_charge":86.45,"discounted_cash":51.87,"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":69.25,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0713-0678-15","type":"NDC"}],"standard_charges":[{"gross_charge":105.85,"discounted_cash":63.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0713-0682-15","type":"NDC"}],"standard_charges":[{"gross_charge":211.95,"discounted_cash":127.17,"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":376.35,"discounted_cash":225.81,"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":"0641-6013-01","type":"NDC"}],"standard_charges":[{"gross_charge":82.9,"discounted_cash":49.74,"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":"0378-8270-93","type":"NDC"}],"standard_charges":[{"gross_charge":11.7,"discounted_cash":7.02,"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":10.98,"discounted_cash":6.59,"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":9.41,"discounted_cash":5.65,"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":6.29,"discounted_cash":3.78,"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":"0406-8003-15","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.43,"discounted_cash":5.06,"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":"0406-8003-30","type":"NDC"}],"standard_charges":[{"gross_charge":8.57,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.05,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-8005-03","type":"NDC"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":12.79,"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":13.4,"discounted_cash":8.04,"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":13.4,"discounted_cash":8.04,"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":14.22,"discounted_cash":8.54,"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":193.6,"discounted_cash":116.16,"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":78.3,"discounted_cash":46.98,"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":57.75,"discounted_cash":34.65,"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":99.4,"discounted_cash":59.64,"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":147.75,"discounted_cash":88.65,"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":124.4,"discounted_cash":74.64,"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":"0409-1631-40","type":"NDC"}],"standard_charges":[{"gross_charge":84.4,"discounted_cash":50.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-1752-50","type":"NDC"}],"standard_charges":[{"gross_charge":124.55,"discounted_cash":74.73,"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":107.37,"discounted_cash":64.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SUFENTANIL CITRATE 50 MCG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3382-21","type":"NDC"}],"standard_charges":[{"gross_charge":72.95,"discounted_cash":43.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHADONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0406-5755-23","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0409-3613-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":1.75,"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":4.65,"discounted_cash":2.79,"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":"0406-0552-01","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":"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":13.35,"discounted_cash":8.01,"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":13.5,"discounted_cash":8.1,"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":14.35,"discounted_cash":8.61,"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":78.3,"discounted_cash":46.98,"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":57.75,"discounted_cash":34.65,"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":99.4,"discounted_cash":59.64,"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":147.75,"discounted_cash":88.65,"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":193.6,"discounted_cash":116.16,"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":14.75,"discounted_cash":8.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PENTAFLUOROPROP-TETRAFLUOROETH EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0386-0008-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ORA-BLEND SF PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0395-0089-16","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":"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":6.97,"discounted_cash":4.18,"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":6.93,"discounted_cash":4.16,"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":10.55,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.34,"discounted_cash":4.40,"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":10.38,"discounted_cash":6.23,"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":"0406-0484-01","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":"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":8.94,"discounted_cash":5.36,"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":10.00,"discounted_cash":6.00,"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":7.51,"discounted_cash":4.50,"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":12.37,"discounted_cash":7.42,"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":"0487-9301-33","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":"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":42.08,"discounted_cash":25.25,"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":8.57,"discounted_cash":5.14,"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":4.42,"discounted_cash":2.65,"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":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0496-0882-05","type":"NDC"}],"standard_charges":[{"gross_charge":74.2,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-2502-01","type":"NDC"}],"standard_charges":[{"gross_charge":206.65,"discounted_cash":123.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-2502-10","type":"NDC"}],"standard_charges":[{"gross_charge":206.65,"discounted_cash":123.99,"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":"0517-3020-25","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":"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":146.33,"discounted_cash":87.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TPN ADULT SMMC WITH ELECTROLYTES CENTRAL LINE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-9305-01","type":"NDC"}],"standard_charges":[{"gross_charge":1416.9,"discounted_cash":850.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TPN ADULT SMMC WITH ELECTROLYTES CENTRAL LINE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0517-9305-25","type":"NDC"}],"standard_charges":[{"gross_charge":1416.9,"discounted_cash":850.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRIMIDONE 125 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":10.65,"discounted_cash":6.39,"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":"0527-1367-01","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":"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":9.30,"discounted_cash":5.58,"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":13.92,"discounted_cash":8.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0472-0337-20","type":"NDC"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":44.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MULTI-VITAMINS PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0440-7830-90","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":"SODIUM HYPOCHLORITE 0.25 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"0436-0936-16","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":55.95,"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":79.15,"discounted_cash":47.49,"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":80.89,"discounted_cash":48.53,"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":"0409-4887-23","type":"NDC"}],"standard_charges":[{"gross_charge":82.08,"discounted_cash":49.24,"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":36.65,"discounted_cash":21.99,"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":81.4,"discounted_cash":48.84,"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":82.9,"discounted_cash":49.74,"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":10.85,"discounted_cash":6.51,"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":131.18,"discounted_cash":78.71,"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":162.58,"discounted_cash":97.54,"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":"0409-7295-11","type":"NDC"}],"standard_charges":[{"gross_charge":113.83,"discounted_cash":68.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":106.91,"discounted_cash":64.14,"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":115.05,"discounted_cash":69.03,"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":"0409-7517-66","type":"NDC"}],"standard_charges":[{"gross_charge":189.92,"discounted_cash":113.95,"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":116.4,"discounted_cash":69.84,"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":"0436-0672-16","type":"NDC"}],"standard_charges":[{"gross_charge":93.25,"discounted_cash":55.95,"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":"0409-5534-14","type":"NDC"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":69.0,"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":"50268-054-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":12.45,"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":14.8,"discounted_cash":8.88,"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":"50268-062-11","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":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-872-01","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":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-872-11","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":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60758-119-05","type":"NDC"}],"standard_charges":[{"gross_charge":223.35,"discounted_cash":134.01,"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":"60758-801-10","type":"NDC"}],"standard_charges":[{"gross_charge":78.1,"discounted_cash":46.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUOROMETHOLONE 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60758-880-05","type":"NDC"}],"standard_charges":[{"gross_charge":356.95,"discounted_cash":214.17,"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":313.39,"discounted_cash":188.04,"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":"60793-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":309.4,"discounted_cash":185.64,"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":290.7,"discounted_cash":174.42,"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":"61314-019-10","type":"NDC"}],"standard_charges":[{"gross_charge":269.8,"discounted_cash":161.88,"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":"61314-126-05","type":"NDC"}],"standard_charges":[{"gross_charge":398.8,"discounted_cash":239.28,"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":"61314-143-05","type":"NDC"}],"standard_charges":[{"gross_charge":156.3,"discounted_cash":93.78,"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":"61314-143-10","type":"NDC"}],"standard_charges":[{"gross_charge":264.75,"discounted_cash":158.85,"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":104.2,"discounted_cash":62.52,"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":"61314-227-10","type":"NDC"}],"standard_charges":[{"gross_charge":155.3,"discounted_cash":93.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CROMOLYN SODIUM 4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"61314-237-10","type":"NDC"}],"standard_charges":[{"gross_charge":171.4,"discounted_cash":102.84,"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":363.85,"discounted_cash":218.31,"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":105.6,"discounted_cash":63.36,"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":231.75,"discounted_cash":139.05,"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":"61314-647-25","type":"NDC"}],"standard_charges":[{"gross_charge":289.15,"discounted_cash":173.49,"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":"60687-861-11","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":"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":77.25,"discounted_cash":46.35,"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":"60687-836-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":4.12,"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":"60687-833-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.86,"discounted_cash":4.12,"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":"60687-735-11","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":"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":8.30,"discounted_cash":4.98,"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":"60687-736-65","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":"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":10.06,"discounted_cash":6.03,"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":31.62,"discounted_cash":18.97,"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":11.31,"discounted_cash":6.79,"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":"60687-752-33","type":"NDC"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":34.56,"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":10.36,"discounted_cash":6.22,"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":6.50,"discounted_cash":3.90,"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":"60687-762-40","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":"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":9.7,"discounted_cash":5.82,"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":"60687-794-01","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":"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":6.98,"discounted_cash":4.19,"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":5.21,"discounted_cash":3.13,"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":7.67,"discounted_cash":4.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.29,"discounted_cash":4.38,"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":15.45,"discounted_cash":9.27,"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":4.26,"discounted_cash":2.56,"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":5.51,"discounted_cash":3.31,"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":6.81,"discounted_cash":4.08,"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":31.70,"discounted_cash":19.02,"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":"61570-131-40","type":"NDC"}],"standard_charges":[{"gross_charge":244.65,"discounted_cash":146.79,"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":"61748-012-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.52,"discounted_cash":14.71,"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":"62584-265-11","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":"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":6.56,"discounted_cash":3.93,"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":8.27,"discounted_cash":4.96,"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":8.66,"discounted_cash":5.20,"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":7.64,"discounted_cash":4.58,"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":"62756-521-69","type":"NDC"}],"standard_charges":[{"gross_charge":95.15,"discounted_cash":57.09,"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":4106.1,"discounted_cash":2463.66,"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":"63323-089-50","type":"NDC"}],"standard_charges":[{"gross_charge":121.48,"discounted_cash":72.89,"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":"0250","type":"RC"},{"code":"63323-130-02","type":"NDC"}],"standard_charges":[{"gross_charge":172.75,"discounted_cash":103.65,"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":94.04,"discounted_cash":56.42,"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":91.3,"discounted_cash":54.78,"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":166.68,"discounted_cash":100.00,"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":"63323-386-20","type":"NDC"}],"standard_charges":[{"gross_charge":261.05,"discounted_cash":156.63,"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":"63323-426-01","type":"NDC"}],"standard_charges":[{"gross_charge":125.28,"discounted_cash":75.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":106.9,"discounted_cash":64.14,"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":120.54,"discounted_cash":72.32,"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":"63323-462-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.11,"discounted_cash":40.27,"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":"62584-265-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":4.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.42,"discounted_cash":4.45,"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":"61570-131-55","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":"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":324.4,"discounted_cash":194.64,"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":593.36,"discounted_cash":356.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TAB-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62175-320-46","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":14.4,"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":15.4,"discounted_cash":9.24,"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":15.4,"discounted_cash":9.24,"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":14.32,"discounted_cash":8.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62332-033-31","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":7.97,"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":119.35,"discounted_cash":71.61,"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":18.28,"discounted_cash":10.97,"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":48.26,"discounted_cash":28.96,"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":136.95,"discounted_cash":82.17,"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":137.58,"discounted_cash":82.54,"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":14.6,"discounted_cash":8.76,"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":"62332-736-31","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":"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":15.6,"discounted_cash":9.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":12.42,"discounted_cash":7.45,"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":12.65,"discounted_cash":7.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TRANEXAMIC ACID 650 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-265-30","type":"NDC"}],"standard_charges":[{"gross_charge":21.95,"discounted_cash":13.17,"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":"62559-420-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDAPAMIDE 1.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"62559-510-01","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":"MECLIZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-730-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.77,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.85,"discounted_cash":5.31,"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":9.16,"discounted_cash":5.50,"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":"60687-524-79","type":"NDC"}],"standard_charges":[{"gross_charge":43.27,"discounted_cash":25.96,"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":"60687-525-11","type":"NDC"}],"standard_charges":[{"gross_charge":114.77,"discounted_cash":68.86,"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":10.25,"discounted_cash":6.15,"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":"60687-540-01","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":"DIGOXIN 125 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-540-11","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":"LEVOTHYROXINE SODIUM 175 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-541-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.66,"discounted_cash":6.39,"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":"60687-544-01","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":"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":9.75,"discounted_cash":5.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.31,"discounted_cash":5.59,"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":"60687-549-11","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":"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":10.4,"discounted_cash":6.24,"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":9.86,"discounted_cash":5.92,"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":"60687-551-11","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":"CLONAZEPAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-555-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.84,"discounted_cash":4.70,"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":"60687-555-11","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":"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":6.82,"discounted_cash":4.09,"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":5.64,"discounted_cash":3.38,"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":"60687-559-11","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":"METHOCARBAMOL 750 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-568-01","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":"LEVOTHYROXINE SODIUM 125 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-519-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.94,"discounted_cash":5.96,"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":8.65,"discounted_cash":5.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PREGABALIN 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-517-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.83,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BACLOFEN 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-514-11","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":"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":9.25,"discounted_cash":5.55,"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":6.73,"discounted_cash":4.04,"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":8.6,"discounted_cash":5.16,"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":8.40,"discounted_cash":5.04,"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":"60687-465-01","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":"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":11.42,"discounted_cash":6.85,"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":7.15,"discounted_cash":4.29,"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":5.52,"discounted_cash":3.31,"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":"60687-480-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.42,"discounted_cash":6.86,"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":"60687-484-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":7.56,"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":"60687-484-11","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":"LEVOTHYROXINE SODIUM 88 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-486-11","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":"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":11.7,"discounted_cash":7.02,"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":"60687-493-11","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":"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":9.07,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-500-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":8.13,"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":10.74,"discounted_cash":6.44,"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":11.03,"discounted_cash":6.62,"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":"60687-508-11","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":"PREGABALIN 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-517-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":7.56,"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":8.12,"discounted_cash":4.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIFAMPIN 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-575-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":9.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"RIFAMPIN 150 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-575-21","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":9.12,"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":9.75,"discounted_cash":5.85,"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":"60687-669-11","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":"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":19.07,"discounted_cash":11.44,"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":"60687-675-11","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":"LACOSAMIDE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-676-57","type":"NDC"}],"standard_charges":[{"gross_charge":9.96,"discounted_cash":5.98,"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":"60687-681-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.15,"discounted_cash":4.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-683-11","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":"ALLOPURINOL 150 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":10.45,"discounted_cash":6.27,"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":8.95,"discounted_cash":5.37,"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":"60687-701-11","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":"LAMOTRIGINE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-704-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.85,"discounted_cash":5.31,"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":11.19,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.77,"discounted_cash":5.86,"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":9.12,"discounted_cash":5.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-722-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.08,"discounted_cash":8.45,"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":32.74,"discounted_cash":19.64,"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":"60687-725-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.60,"discounted_cash":9.96,"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":17.78,"discounted_cash":10.67,"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":7.70,"discounted_cash":4.62,"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":7.13,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":10.1,"discounted_cash":6.06,"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":"60687-656-21","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":"HYDROMORPHONE HCL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-579-11","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":"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":7.47,"discounted_cash":4.48,"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":9.62,"discounted_cash":5.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBAMAZEPINE ER 200 MG PO TAB-SR-12HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-583-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.87,"discounted_cash":11.32,"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":19.5,"discounted_cash":11.7,"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":8.12,"discounted_cash":4.87,"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":"60687-588-11","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":"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":9.75,"discounted_cash":5.85,"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":8.19,"discounted_cash":4.92,"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":"63323-468-02","type":"NDC"}],"standard_charges":[{"gross_charge":77.15,"discounted_cash":46.29,"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":7.78,"discounted_cash":4.67,"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":"60687-596-33","type":"NDC"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":35.4,"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":9.15,"discounted_cash":5.49,"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":8.57,"discounted_cash":5.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROPRANOLOL HCL 40 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-609-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.78,"discounted_cash":5.27,"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":11.4,"discounted_cash":6.84,"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":"60687-619-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.75,"discounted_cash":12.45,"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":"60687-620-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.65,"discounted_cash":5.79,"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":5.44,"discounted_cash":3.26,"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":9.65,"discounted_cash":5.79,"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":7.18,"discounted_cash":4.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 12.5-125 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":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.96,"discounted_cash":5.97,"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":"68084-097-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.74,"discounted_cash":5.24,"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":10.19,"discounted_cash":6.12,"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":"68084-099-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.41,"discounted_cash":5.04,"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":31.98,"discounted_cash":19.19,"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":"68084-107-11","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":"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":14.7,"discounted_cash":8.82,"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":"68084-111-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":3.93,"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":8.84,"discounted_cash":5.30,"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":11.55,"discounted_cash":6.93,"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":"68084-157-11","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":"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":9.3,"discounted_cash":5.58,"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":"68084-202-01","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":"PRIMIDONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-202-11","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":"PRIMIDONE 125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-203-01","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":"PRIMIDONE 250 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-203-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.31,"discounted_cash":5.59,"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":"68084-204-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":5.46,"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":"68084-093-11","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":"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":9.71,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-083-11","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":"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":11.05,"discounted_cash":6.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":11.45,"discounted_cash":6.87,"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":14.25,"discounted_cash":8.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CARVEDILOL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-152-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.22,"discounted_cash":8.53,"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":12.13,"discounted_cash":7.28,"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":5.48,"discounted_cash":3.28,"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":7.68,"discounted_cash":4.61,"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":"68001-335-00","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":"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":23.60,"discounted_cash":14.16,"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":14.25,"discounted_cash":8.55,"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":14.44,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LORATADINE 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-449-98","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":"DIVALPROEX SODIUM 500 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-474-00","type":"NDC"}],"standard_charges":[{"gross_charge":17.8,"discounted_cash":10.68,"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":60.25,"discounted_cash":36.15,"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":58.55,"discounted_cash":35.13,"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":71.7,"discounted_cash":43.02,"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":"68001-485-00","type":"NDC"}],"standard_charges":[{"gross_charge":26.45,"discounted_cash":15.87,"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":20.13,"discounted_cash":12.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ PO CAP-CONT-REL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68001-619-00","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":"WARFARIN SODIUM 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-027-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":5.7,"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":14.03,"discounted_cash":8.42,"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":9.68,"discounted_cash":5.81,"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":"68084-269-11","type":"NDC"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":12.84,"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":19.8,"discounted_cash":11.88,"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":8.77,"discounted_cash":5.26,"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":"68084-415-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.51,"discounted_cash":11.11,"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":8.52,"discounted_cash":5.11,"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":9.15,"discounted_cash":5.49,"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":"68084-479-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.8,"discounted_cash":5.88,"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":8.95,"discounted_cash":5.37,"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":"68084-480-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":7.96,"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":"68084-490-11","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":"MECLIZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-491-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.08,"discounted_cash":5.44,"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":"68084-494-11","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":"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":19.61,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.3,"discounted_cash":9.78,"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":21.35,"discounted_cash":12.81,"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":"68084-536-11","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":"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":7.71,"discounted_cash":4.63,"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":32.15,"discounted_cash":19.29,"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":33.95,"discounted_cash":20.37,"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":10.45,"discounted_cash":6.27,"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":5.25,"discounted_cash":3.15,"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":8.72,"discounted_cash":5.23,"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":"68084-376-11","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":"OXYCODONE HCL 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":7.47,"discounted_cash":4.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.2,"discounted_cash":4.92,"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":18.22,"discounted_cash":10.93,"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":18.41,"discounted_cash":11.05,"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":12.65,"discounted_cash":7.59,"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":8.69,"discounted_cash":5.22,"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":11.86,"discounted_cash":7.12,"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":6.46,"discounted_cash":3.88,"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":10.8,"discounted_cash":6.48,"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":9.44,"discounted_cash":5.67,"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":"68084-299-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":12.51,"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":194.45,"discounted_cash":116.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DANTROLENE SODIUM 25 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-300-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.65,"discounted_cash":8.19,"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":6.2,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMOTRIGINE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"68084-318-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":3.29,"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":6.71,"discounted_cash":4.03,"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":"68084-326-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.68,"discounted_cash":5.21,"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":9.80,"discounted_cash":5.88,"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":25.70,"discounted_cash":15.42,"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":12.8,"discounted_cash":7.68,"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":12.8,"discounted_cash":7.68,"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":12.03,"discounted_cash":7.22,"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":13.03,"discounted_cash":7.82,"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":"60687-453-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.76,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORTHALIDONE 25 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":10.47,"discounted_cash":6.28,"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":"67877-589-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.85,"discounted_cash":17.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":28.68,"discounted_cash":17.21,"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":6.91,"discounted_cash":4.14,"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":"63739-796-10","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":"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":572.55,"discounted_cash":343.53,"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":"64281-110-06","type":"NDC"}],"standard_charges":[{"gross_charge":572.55,"discounted_cash":343.53,"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":7.15,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.85,"discounted_cash":5.31,"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":8.75,"discounted_cash":5.25,"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":6.62,"discounted_cash":3.97,"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":8.55,"discounted_cash":5.13,"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":"64980-290-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.81,"discounted_cash":5.89,"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":338.3,"discounted_cash":202.98,"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":97.5,"discounted_cash":58.5,"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":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILDENAFIL CITRATE 20 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":76.80,"discounted_cash":46.08,"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":12.40,"discounted_cash":7.44,"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":98.58,"discounted_cash":59.15,"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":72.92,"discounted_cash":43.75,"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":95.15,"discounted_cash":57.09,"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":"65282-1605-1","type":"NDC"}],"standard_charges":[{"gross_charge":82.5,"discounted_cash":49.5,"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":"63739-572-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.15,"discounted_cash":4.89,"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":"65628-204-05","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":"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":6.98,"discounted_cash":4.19,"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":0.15,"discounted_cash":0.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"63323-488-07","type":"NDC"}],"standard_charges":[{"gross_charge":142.15,"discounted_cash":85.29,"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":76.63,"discounted_cash":45.98,"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":73.93,"discounted_cash":44.36,"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":68.09,"discounted_cash":40.85,"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":79.27,"discounted_cash":47.56,"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":"63323-781-21","type":"NDC"}],"standard_charges":[{"gross_charge":98.5,"discounted_cash":59.1,"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":"63323-881-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.46,"discounted_cash":82.47,"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":"63402-302-30","type":"NDC"}],"standard_charges":[{"gross_charge":205.4,"discounted_cash":123.24,"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":"63402-304-30","type":"NDC"}],"standard_charges":[{"gross_charge":201.68,"discounted_cash":121.00,"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":125.7,"discounted_cash":75.42,"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":4.12,"discounted_cash":2.47,"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":0.09,"discounted_cash":0.06,"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":43.39,"discounted_cash":26.04,"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":240.52,"discounted_cash":144.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"AMOXICILLIN 875 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-015-01","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":"INDOCYANINE GREEN 25 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66259-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":937.55,"discounted_cash":562.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1080.8,"discounted_cash":648.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INDOCYANINE GREEN 25 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66259-936-15","type":"NDC"}],"standard_charges":[{"gross_charge":301.42,"discounted_cash":180.86,"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":0.15,"discounted_cash":0.09,"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":0.10,"discounted_cash":0.06,"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":"66553-004-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":2.83,"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":"66689-023-50","type":"NDC"}],"standard_charges":[{"gross_charge":21.35,"discounted_cash":12.81,"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":"66689-036-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.6,"discounted_cash":22.56,"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":"66689-202-08","type":"NDC"}],"standard_charges":[{"gross_charge":121.61,"discounted_cash":72.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACTIDOSE WITH SORBITOL 50 GM/240ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"66689-203-08","type":"NDC"}],"standard_charges":[{"gross_charge":125.37,"discounted_cash":75.22,"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":15.8,"discounted_cash":9.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POVIDONE-IODINE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67618-150-04","type":"NDC"}],"standard_charges":[{"gross_charge":54.3,"discounted_cash":32.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POVIDONE-IODINE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67618-150-05","type":"NDC"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":31.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"POVIDONE-IODINE 7.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"67618-151-04","type":"NDC"}],"standard_charges":[{"gross_charge":64.05,"discounted_cash":38.43,"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":79.79,"discounted_cash":47.88,"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":151.85,"discounted_cash":91.11,"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":9.1,"discounted_cash":5.46,"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":648.1,"discounted_cash":388.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOLIFENACIN SUCCINATE 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":50.80,"discounted_cash":30.48,"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":"65862-930-08","type":"NDC"}],"standard_charges":[{"gross_charge":71.25,"discounted_cash":42.75,"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":62.5,"discounted_cash":37.5,"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":"65862-892-30","type":"NDC"}],"standard_charges":[{"gross_charge":182.75,"discounted_cash":109.65,"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":8.42,"discounted_cash":5.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"NEVIRAPINE 50 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-057-24","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":"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":96.98,"discounted_cash":58.18,"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":93.16,"discounted_cash":55.90,"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":22.71,"discounted_cash":13.63,"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":"65862-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":3.12,"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":35.35,"discounted_cash":21.21,"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":"65862-448-90","type":"NDC"}],"standard_charges":[{"gross_charge":28.4,"discounted_cash":17.04,"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":19.5,"discounted_cash":11.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ENTACAPONE 200 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":21.85,"discounted_cash":13.11,"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":18.05,"discounted_cash":10.83,"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":"65862-676-01","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":"ALPRAZOLAM 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"65862-678-01","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":"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":23.6,"discounted_cash":14.16,"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":17.77,"discounted_cash":10.66,"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":"65862-709-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":18.06,"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":"65862-758-90","type":"NDC"}],"standard_charges":[{"gross_charge":34.2,"discounted_cash":20.52,"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":26.83,"discounted_cash":16.10,"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":23.51,"discounted_cash":14.11,"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":9.35,"discounted_cash":5.61,"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":"60687-671-40","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":11.33,"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":7.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":8.85,"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":7.56,"discounted_cash":4.53,"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":"51079-073-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.8,"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":"51079-075-01","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":"SPIRONOLACTONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.85,"discounted_cash":5.31,"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":9.28,"discounted_cash":5.57,"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":7.58,"discounted_cash":4.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.16,"discounted_cash":4.90,"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":9.9,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.90,"discounted_cash":5.94,"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":"51079-209-01","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":"METOPROLOL TARTRATE 12.5 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":8.25,"discounted_cash":4.95,"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":7.77,"discounted_cash":4.66,"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":"51079-284-20","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":"DIAZEPAM 2.5 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":8.5,"discounted_cash":5.1,"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":"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":8.5,"discounted_cash":5.1,"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":"51079-374-01","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":"PANTOPRAZOLE SODIUM 40 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.2,"discounted_cash":14.52,"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":8.77,"discounted_cash":5.26,"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":"51079-023-01","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":"BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-364-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.78,"discounted_cash":21.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-12 500 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-854-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":3.98,"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"},{"gross_charge":8.5,"discounted_cash":5.1,"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":"50268-860-11","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":"ASCORBIC ACID 250 MG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-860-15","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":"VITAMIN D3 10 MCG (400 UNIT) PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-863-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.35,"discounted_cash":5.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.41,"discounted_cash":3.84,"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":"50268-863-15","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":"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":57.68,"discounted_cash":34.61,"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":"50383-775-15","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":"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":47.93,"discounted_cash":28.76,"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":82.76,"discounted_cash":49.66,"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":78.49,"discounted_cash":47.09,"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":86.03,"discounted_cash":51.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BRIVARACETAM 100 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50474-770-66","type":"NDC"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":66.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROTIGOTINE 4 MG/24HR TD PT24","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50474-804-03","type":"NDC"}],"standard_charges":[{"gross_charge":124.33,"discounted_cash":74.60,"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":1293.51,"discounted_cash":776.11,"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":8.3,"discounted_cash":4.98,"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":"50742-239-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 240 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50742-250-90","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":8.4,"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":8.33,"discounted_cash":5.00,"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":"51079-437-01","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":"MIDODRINE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-453-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.70,"discounted_cash":8.22,"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":"51672-1258-2","type":"NDC"}],"standard_charges":[{"gross_charge":901.35,"discounted_cash":540.81,"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":130.8,"discounted_cash":78.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"HYDROCORTISONE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-2010-2","type":"NDC"}],"standard_charges":[{"gross_charge":65.05,"discounted_cash":39.03,"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":9.70,"discounted_cash":5.82,"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":7.74,"discounted_cash":4.64,"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":14.23,"discounted_cash":8.54,"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":7.02,"discounted_cash":4.21,"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":10.20,"discounted_cash":6.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMOTRIGINE 200 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51672-4133-4","type":"NDC"}],"standard_charges":[{"gross_charge":26.95,"discounted_cash":16.17,"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":191.38,"discounted_cash":114.83,"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":22.14,"discounted_cash":13.28,"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":"51754-0503-3","type":"NDC"}],"standard_charges":[{"gross_charge":34.25,"discounted_cash":20.55,"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":58.46,"discounted_cash":35.07,"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":"51754-5011-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.34,"discounted_cash":25.41,"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":42.34,"discounted_cash":25.41,"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":"51862-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.34,"discounted_cash":5.60,"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":277.6,"discounted_cash":166.56,"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":"51862-486-01","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":"TETRACYCLINE HCL 500 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51991-907-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.4,"discounted_cash":37.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ACETIC ACID 5 % SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51552-0055-6","type":"NDC"}],"standard_charges":[{"gross_charge":71.54,"discounted_cash":42.93,"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":"51079-440-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.43,"discounted_cash":5.06,"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":"51224-022-06","type":"NDC"}],"standard_charges":[{"gross_charge":30.88,"discounted_cash":18.52,"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":"51079-985-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.9,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FUROSEMIDE 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-527-01","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":"THIORIDAZINE HCL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-566-01","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":"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":8.62,"discounted_cash":5.17,"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":8.6,"discounted_cash":5.16,"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":4.50,"discounted_cash":2.70,"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":8.45,"discounted_cash":5.07,"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":"51079-753-01","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":"ATENOLOL 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-759-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"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":10.0,"discounted_cash":6.0,"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":20.95,"discounted_cash":12.57,"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":9.3,"discounted_cash":5.58,"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":"51079-886-01","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":"METOCLOPRAMIDE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-886-20","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":"METOCLOPRAMIDE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-888-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-888-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"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":"51079-923-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUSPIRONE HCL 15 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-960-01","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":"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":9.08,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"51079-986-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":6.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN B-12 500 MCG PO TABS WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-854-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.18,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":5.70,"discounted_cash":3.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-297-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.55,"discounted_cash":8.13,"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":17.4,"discounted_cash":10.44,"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":"50268-314-15","type":"NDC"}],"standard_charges":[{"gross_charge":17.4,"discounted_cash":10.44,"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":26.12,"discounted_cash":15.67,"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":"50268-330-11","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":"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":23.0,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"FLUCONAZOLE 100 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":64.35,"discounted_cash":38.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":63.39,"discounted_cash":38.03,"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":"50268-350-11","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":"GLIMEPIRIDE 1 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-358-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":5.75,"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":8.2,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":6.98,"discounted_cash":4.19,"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":9.13,"discounted_cash":5.48,"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":"50268-400-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.28,"discounted_cash":5.57,"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":"50268-401-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.65,"discounted_cash":6.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.41,"discounted_cash":5.04,"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":"50268-401-15","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 10-325 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-402-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.95,"discounted_cash":7.17,"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":"50268-279-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.45,"discounted_cash":14.67,"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":"50268-402-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.45,"discounted_cash":7.47,"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":9.37,"discounted_cash":5.62,"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":7.24,"discounted_cash":4.34,"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":"50268-069-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.5,"discounted_cash":11.1,"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":8.23,"discounted_cash":4.94,"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":"50268-075-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.05,"discounted_cash":8.43,"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":107.91,"discounted_cash":64.75,"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":84.67,"discounted_cash":50.80,"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":"50268-106-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.91,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.85,"discounted_cash":4.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.27,"discounted_cash":4.96,"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":12.3,"discounted_cash":7.38,"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":12.5,"discounted_cash":7.5,"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":14.2,"discounted_cash":8.52,"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":10.58,"discounted_cash":6.35,"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":12.24,"discounted_cash":7.34,"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":12.07,"discounted_cash":7.24,"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":74.45,"discounted_cash":44.67,"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":"50268-184-12","type":"NDC"}],"standard_charges":[{"gross_charge":74.65,"discounted_cash":44.79,"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":30.05,"discounted_cash":18.03,"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":30.3,"discounted_cash":18.18,"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":11.4,"discounted_cash":6.84,"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":5.16,"discounted_cash":3.10,"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":6.35,"discounted_cash":3.81,"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":"50268-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":23.48,"discounted_cash":14.08,"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":70.45,"discounted_cash":42.27,"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":30.05,"discounted_cash":18.03,"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":34.77,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOTALOL HCL 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-724-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.63,"discounted_cash":8.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOTALOL HCL 80 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-724-15","type":"NDC"}],"standard_charges":[{"gross_charge":14.85,"discounted_cash":8.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SOTALOL HCL 120 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-725-11","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":"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":9.55,"discounted_cash":5.73,"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":8.46,"discounted_cash":5.08,"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":8.50,"discounted_cash":5.10,"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":9.5,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"ROPINIROLE HCL 2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-744-11","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":"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":37.45,"discounted_cash":22.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"TORSEMIDE 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-754-11","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":"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":9.75,"discounted_cash":5.85,"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":"50268-760-11","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":"TERAZOSIN HCL 1 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-764-11","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":"TERAZOSIN HCL 5 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-766-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.07,"discounted_cash":6.04,"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":15.40,"discounted_cash":9.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CYANOCOBALAMIN 100 MCG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-852-11","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":"VITAMIN B-12 250 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":3.97,"discounted_cash":2.38,"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":"50268-686-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PRIMIDONE 50 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-686-11","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":"PRAVASTATIN SODIUM 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-665-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.65,"discounted_cash":9.99,"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":10.35,"discounted_cash":6.21,"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":"50268-489-11","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":"LORATADINE 10 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"50268-489-15","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":"LOSARTAN POTASSIUM 12.5 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":9.35,"discounted_cash":5.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":9.23,"discounted_cash":5.54,"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":6.84,"discounted_cash":4.11,"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":9.9,"discounted_cash":5.94,"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":"50268-525-11","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":"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":10.05,"discounted_cash":6.03,"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":"50268-540-11","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":"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":1077.75,"discounted_cash":646.65,"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":"50268-541-11","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":"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":10.1,"discounted_cash":6.06,"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":9.95,"discounted_cash":5.97,"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":9.25,"discounted_cash":5.55,"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":6.35,"discounted_cash":3.81,"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":"50268-630-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.25,"discounted_cash":11.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":16.35,"discounted_cash":9.81,"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":"50268-632-11","type":"NDC"}],"standard_charges":[{"gross_charge":25.14,"discounted_cash":15.09,"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":"50268-632-15","type":"NDC"}],"standard_charges":[{"gross_charge":26.83,"discounted_cash":16.1,"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":8.98,"discounted_cash":5.39,"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":8.25,"discounted_cash":4.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"THEOPHYLLINE ER 100 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"52244-100-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.68,"discounted_cash":11.21,"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":0.07,"discounted_cash":0.04,"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":"52536-104-05","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":"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":22.73,"discounted_cash":13.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"METHADONE HCL 5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-214-11","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":"DILTIAZEM HCL ER COATED BEADS 240 MG PO CAP-SR-24HR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-217-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"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":14.8,"discounted_cash":8.88,"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":"60687-226-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.44,"discounted_cash":8.06,"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":9.67,"discounted_cash":5.80,"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":8.84,"discounted_cash":5.31,"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":8.12,"discounted_cash":4.88,"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":8.65,"discounted_cash":5.19,"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":5.04,"discounted_cash":3.02,"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":28.25,"discounted_cash":16.95,"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":"60687-245-65","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":"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":27.93,"discounted_cash":16.76,"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":"60687-252-40","type":"NDC"}],"standard_charges":[{"gross_charge":38.97,"discounted_cash":23.38,"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":"60687-272-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.82,"discounted_cash":10.10,"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":"60687-282-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.26,"discounted_cash":10.36,"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":9.62,"discounted_cash":5.77,"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":"60687-293-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.39,"discounted_cash":5.03,"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":9.93,"discounted_cash":5.96,"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":9.38,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CAPTOPRIL 6.25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-304-21","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":"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":"60687-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.82,"discounted_cash":5.29,"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":21.32,"discounted_cash":12.79,"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":50.73,"discounted_cash":30.44,"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":65.05,"discounted_cash":39.03,"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":198.95,"discounted_cash":119.37,"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":"60505-6226-1","type":"NDC"}],"standard_charges":[{"gross_charge":232.2,"discounted_cash":139.32,"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":13.6,"discounted_cash":8.16,"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":14.7,"discounted_cash":8.82,"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":15.65,"discounted_cash":9.39,"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":14.05,"discounted_cash":8.43,"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":"60687-113-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.78,"discounted_cash":4.06,"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":8.51,"discounted_cash":5.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLONIDINE HCL 0.2 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-124-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":5.15,"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":11.3,"discounted_cash":6.78,"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":9.75,"discounted_cash":5.85,"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":8.20,"discounted_cash":4.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":7.27,"discounted_cash":4.36,"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":10.97,"discounted_cash":6.58,"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":"60687-168-11","type":"NDC"}],"standard_charges":[{"gross_charge":112.25,"discounted_cash":67.35,"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":17.6,"discounted_cash":10.56,"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":"60687-184-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"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":9.80,"discounted_cash":5.88,"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":448.1,"discounted_cash":268.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-317-11","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":"CHLORTHALIDONE 12.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-317-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.75,"discounted_cash":8.85,"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":8.6,"discounted_cash":5.16,"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":134.14,"discounted_cash":80.49,"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":8.38,"discounted_cash":5.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"CLOZAPINE 25 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":5.61,"discounted_cash":3.37,"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":9.93,"discounted_cash":5.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MESALAMINE 800 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-408-25","type":"NDC"}],"standard_charges":[{"gross_charge":64.7,"discounted_cash":38.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MESALAMINE 800 MG PO TBEC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-408-95","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":"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":15.98,"discounted_cash":9.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"SILDENAFIL CITRATE 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-416-11","type":"NDC"}],"standard_charges":[{"gross_charge":78.05,"discounted_cash":46.83,"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":17.24,"discounted_cash":10.35,"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":"60687-417-71","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":"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":10.95,"discounted_cash":6.57,"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":"60687-428-11","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":"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":14.11,"discounted_cash":8.46,"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":15.60,"discounted_cash":9.36,"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":4.90,"discounted_cash":2.94,"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":9.4,"discounted_cash":5.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LABETALOL HCL 100 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":8.93,"discounted_cash":5.36,"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":7.95,"discounted_cash":4.77,"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":8.60,"discounted_cash":5.16,"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":"60687-391-11","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":"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":10.98,"discounted_cash":6.59,"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":10.93,"discounted_cash":6.56,"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":"60687-325-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.74,"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":"60687-327-11","type":"NDC"}],"standard_charges":[{"gross_charge":16.91,"discounted_cash":10.14,"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":9.59,"discounted_cash":5.75,"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":26.70,"discounted_cash":16.02,"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":13.15,"discounted_cash":7.89,"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":"60687-356-11","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":"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":9.4,"discounted_cash":5.64,"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":"DICYCLOMINE HCL 10 MG PO CAPS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-369-01","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":"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":46.38,"discounted_cash":27.83,"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":7.94,"discounted_cash":4.76,"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":34.4,"discounted_cash":20.64,"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":"60687-377-01","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":"ALPRAZOLAM 0.125 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-377-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.48,"discounted_cash":3.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":8.60,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DICYCLOMINE HCL 20 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-380-11","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":"MIDODRINE HCL 2.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-387-11","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":"ALPRAZOLAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-388-01","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":"ALPRAZOLAM 0.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60687-388-11","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":"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":44.86,"discounted_cash":26.92,"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":7.61,"discounted_cash":4.56,"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":"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":6.89,"discounted_cash":4.14,"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":331.45,"discounted_cash":198.87,"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":2222.31,"discounted_cash":1333.39,"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":"57237-007-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":9.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"MIRTAZAPINE 15 MG PO TAB-DISPERSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-011-06","type":"NDC"}],"standard_charges":[{"gross_charge":13.70,"discounted_cash":8.22,"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":"57237-030-01","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":"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":12.20,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"LAMIVUDINE 10 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-274-24","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":"GLYCERIN (LAXATIVE) 2 G RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57237-325-21","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":"TPN ADULT SMMC WITH ELECTROLYTES CENTRAL LINE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57513-564-91","type":"NDC"}],"standard_charges":[{"gross_charge":1416.9,"discounted_cash":850.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":97.85,"discounted_cash":58.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"VENLAFAXINE HCL 37.5 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57664-393-88","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":6.04,"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":11.87,"discounted_cash":7.12,"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":"57664-502-89","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":6.81,"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":6.59,"discounted_cash":3.95,"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":14.5,"discounted_cash":8.7,"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":"57896-143-09","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":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"57896-143-14","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":"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":1502.2,"discounted_cash":901.32,"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":52.85,"discounted_cash":31.71,"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":"55513-073-30","type":"NDC"}],"standard_charges":[{"gross_charge":120.05,"discounted_cash":72.03,"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":"55150-426-01","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":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"53462-003-15","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":32.4,"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":26.90,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":26.95,"discounted_cash":16.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"PROBIOTIC PO PACK WRAPPER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54482-922-03","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"INFUVITE ADULT IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"54643-5649-1","type":"NDC"}],"standard_charges":[{"gross_charge":27.7,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":133.35,"discounted_cash":80.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":1416.9,"discounted_cash":850.14,"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":10.88,"discounted_cash":6.53,"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":"55111-671-06","type":"NDC"}],"standard_charges":[{"gross_charge":104.6,"discounted_cash":62.76,"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":"55150-162-05","type":"NDC"}],"standard_charges":[{"gross_charge":83.37,"discounted_cash":50.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"},{"gross_charge":79.43,"discounted_cash":47.66,"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":36.8,"discounted_cash":22.08,"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":91.34,"discounted_cash":54.80,"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":85.04,"discounted_cash":51.02,"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":89.54,"discounted_cash":53.72,"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":449.82,"discounted_cash":269.90,"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":48.15,"discounted_cash":28.89,"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":7.40,"discounted_cash":4.44,"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":0.15,"discounted_cash":0.09,"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":"59762-0401-1","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":"COLESTIPOL HCL 1 G PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"59762-0450-1","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":"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":32.85,"discounted_cash":19.71,"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":4.60,"discounted_cash":2.76,"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":"60219-1264-1","type":"NDC"}],"standard_charges":[{"gross_charge":56.95,"discounted_cash":34.17,"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":61.40,"discounted_cash":36.84,"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":39.99,"discounted_cash":24.00,"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":"60219-1749-3","type":"NDC"}],"standard_charges":[{"gross_charge":241.95,"discounted_cash":145.17,"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":364.75,"discounted_cash":218.85,"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":9.01,"discounted_cash":5.41,"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":7.02,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"DOXAZOSIN MESYLATE 4 MG PO TABS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"60505-0095-0","type":"NDC"}],"standard_charges":[{"gross_charge":10.22,"discounted_cash":6.13,"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":8.07,"discounted_cash":4.84,"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":"60505-0251-3","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":6.81,"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":604.7,"discounted_cash":362.82,"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":408.29,"discounted_cash":244.98,"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":57.2,"discounted_cash":34.32,"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":366.2,"discounted_cash":219.72,"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":11.41,"discounted_cash":6.85,"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":19.26,"discounted_cash":11.56,"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":10.96,"discounted_cash":6.58,"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":12.55,"discounted_cash":7.53,"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":0.15,"discounted_cash":0.09,"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":923.0,"discounted_cash":553.8,"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":"58468-0132-1","type":"NDC"}],"standard_charges":[{"gross_charge":82.2,"discounted_cash":49.32,"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":21.43,"discounted_cash":12.86,"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":"58657-810-21","type":"NDC"}],"standard_charges":[{"gross_charge":35.00,"discounted_cash":21.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: pharmacy"}]},{"description":"GLYCERIN (INFANTS & CHILDREN) 1 G RE SUPP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0250","type":"RC"},{"code":"58980-409-12","type":"NDC"}],"standard_charges":[{"gross_charge":10.15,"discounted_cash":6.09,"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":"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":172.35,"discounted_cash":103.41,"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":27.48,"discounted_cash":16.49,"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":9.45,"discounted_cash":5.67,"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":43.35,"discounted_cash":26.01,"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":9.92,"discounted_cash":5.95,"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":43.35,"discounted_cash":26.01,"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":"59651-390-01","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":"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":155.33,"discounted_cash":93.20,"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":30.32,"discounted_cash":18.19,"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":"59651-456-01","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":"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":12.55,"discounted_cash":7.53,"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":"59651-008-15","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":"HC ROOM & CARE PRIVATE","code_information":[{"code":"1100001","type":"CDM"},{"code":"0110","type":"RC"},{"code":"1100001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":1609.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ROOM & CARE SEMI-PRIVATE","code_information":[{"code":"1200001","type":"CDM"},{"code":"0120","type":"RC"},{"code":"1200001","type":"HCPCS"}],"standard_charges":[{"gross_charge":2682.0,"discounted_cash":1609.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3522.0,"discounted_cash":2113.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2682.0,"discounted_cash":1609.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2682.0,"discounted_cash":1609.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2682.0,"discounted_cash":1609.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3695.0,"discounted_cash":2217.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ROOM & CARE NEWBORN LEVEL III","code_information":[{"code":"1730001","type":"CDM"},{"code":"0173","type":"RC"},{"code":"1730001","type":"HCPCS"}],"standard_charges":[{"gross_charge":4716.0,"discounted_cash":2829.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ROOM & CARE INTENSIVE CARE","code_information":[{"code":"2000001","type":"CDM"},{"code":"0200","type":"RC"},{"code":"2000001","type":"HCPCS"}],"standard_charges":[{"gross_charge":4716.0,"discounted_cash":2829.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":149.0,"discounted_cash":89.4,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":741.0,"discounted_cash":444.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":741.0,"discounted_cash":444.6,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":97.0,"discounted_cash":58.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":97.0,"discounted_cash":58.2,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":215.0,"discounted_cash":129.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":215.0,"discounted_cash":129.0,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":280.0,"discounted_cash":168.0,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":280.0,"discounted_cash":168.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":949.0,"discounted_cash":569.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":949.0,"discounted_cash":569.4,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":474.0,"discounted_cash":284.4,"setting":"inpatient","modifier_code":["JC"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":474.0,"discounted_cash":284.4,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1962.0,"discounted_cash":1177.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1962.0,"discounted_cash":1177.2,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2170.0,"discounted_cash":1302.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2170.0,"discounted_cash":1302.0,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1153.0,"discounted_cash":691.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1153.0,"discounted_cash":691.8,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":503.0,"discounted_cash":301.8,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":503.0,"discounted_cash":301.8,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":503.0,"discounted_cash":301.8,"setting":"inpatient","modifier_code":["JW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CATHETER CENTRAL VENOUS TRIPLE LUMEN ANTIMICROBIAL 5FR X","code_information":[{"code":"2706079","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CATHETER PICC POWER INJECTION SINGLE LUMEN WITH NITINOL G","code_information":[{"code":"2706390","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CATHETER PICC POWER INJECTION SINGLE LUMEN WITH NITINOL G","code_information":[{"code":"2710635","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CATHETER CERVICAL PHERESIS TL PHERESFLO BMT 12.5FR 48CM S","code_information":[{"code":"2713120","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3064.0,"discounted_cash":1838.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CASE TRAVEL HEARTMATE","code_information":[{"code":"2713317","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q0507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NEEDLE BREAST MAMMOGRAPHY LOCALIZATION ULTRA HOMER WITH J","code_information":[{"code":"2713828","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1819","type":"HCPCS"}],"standard_charges":[{"gross_charge":513.0,"discounted_cash":307.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SUPP WRIST FORARM RT THMB STRAP VINYL LPLK SM","code_information":[{"code":"2719002","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3999","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SUPP ANKLE AIRCAST FM WALK SM","code_information":[{"code":"2721626","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"gross_charge":1905.0,"discounted_cash":1143.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BRACE KNEE SHORTRUNNER MED","code_information":[{"code":"2724029","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L1832","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BOOT CAST SYS LG","code_information":[{"code":"2726830","type":"CDM"},{"code":"0270","type":"RC"},{"code":"Q4038","type":"HCPCS"}],"standard_charges":[{"gross_charge":976.0,"discounted_cash":585.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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: SMMCOP"}]},{"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: SMMCOP"}]},{"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":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":296.0,"discounted_cash":177.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GENERAL HEALTH PANEL","code_information":[{"code":"3000008","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":1388.0,"discounted_cash":832.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":774.0,"discounted_cash":464.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ELECTROLYTE PANEL","code_information":[{"code":"3000009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":153.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC COMPREHENSIVE METABOLIC PANEL","code_information":[{"code":"3000010","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":313.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC OBSTETRIC PANEL","code_information":[{"code":"3000011","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.0,"discounted_cash":904.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":796.0,"discounted_cash":477.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LIPID PANEL","code_information":[{"code":"3000012","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.0,"discounted_cash":142.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":268.0,"discounted_cash":160.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC RENAL FUNCTION PANEL","code_information":[{"code":"3000013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":265.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1896.0,"discounted_cash":1137.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":687.0,"discounted_cash":412.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEPATIC FUNCTION PANEL","code_information":[{"code":"3000015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":279.0,"discounted_cash":167.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY, CARBAMAZEPINE, TOTAL","code_information":[{"code":"3000022","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":202.0,"discounted_cash":121.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":602.0,"discounted_cash":361.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":583.0,"discounted_cash":349.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":115.0,"discounted_cash":69.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF GENTAMICIN","code_information":[{"code":"3000029","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":330.0,"discounted_cash":198.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF LITHIUM","code_information":[{"code":"3000032","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PHENOBARBITAL","code_information":[{"code":"3000034","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PHENYTOIN, TOTAL","code_information":[{"code":"3000035","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":220.0,"discounted_cash":132.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":389.0,"discounted_cash":233.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":377.0,"discounted_cash":226.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":779.0,"discounted_cash":467.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":755.0,"discounted_cash":453.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF THEOPHYLLINE","code_information":[{"code":"3000043","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF TOBRAMYCIN","code_information":[{"code":"3000044","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":225.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF VANCOMYCIN","code_information":[{"code":"3000046","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":389.0,"discounted_cash":233.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":336.0,"discounted_cash":201.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC QUANTITATIVE ASSAY, DRUG","code_information":[{"code":"3000047","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URINALYSIS, AUTO W/SCOPE","code_information":[{"code":"3000050","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":129.0,"discounted_cash":77.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":125.0,"discounted_cash":75.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URINALYSIS REAGENT STRIP","code_information":[{"code":"3000053","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":137.0,"discounted_cash":82.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URINALYSIS; MICROSCOPIC ONLY","code_information":[{"code":"3000054","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81015","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":137.0,"discounted_cash":82.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URINE PREGNANCY TEST, QUAL","code_information":[{"code":"3000055","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URINALYSIS, VOLUME MEASURE","code_information":[{"code":"3000056","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.0,"discounted_cash":45.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":68.0,"discounted_cash":40.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BETA HYDROXYBUTYRATE LAB TEST","code_information":[{"code":"3000059","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":141.0,"discounted_cash":84.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":129.0,"discounted_cash":77.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE","code_information":[{"code":"3000065","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":491.0,"discounted_cash":294.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":462.0,"discounted_cash":277.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":289.0,"discounted_cash":173.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":278.0,"discounted_cash":166.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ALPHA-FETOPROTEIN, SERUM","code_information":[{"code":"3000071","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":407.0,"discounted_cash":244.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":383.0,"discounted_cash":229.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":370.0,"discounted_cash":222.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC AMINO ACIDS, QUANTITATIVE","code_information":[{"code":"3000078","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":443.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":677.0,"discounted_cash":406.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC AMMONIA","code_information":[{"code":"3000079","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC AMNIOTIC FLUID SCAN","code_information":[{"code":"3000080","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82143","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":168.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC AMYLASE","code_information":[{"code":"3000082","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PED PROF ANDROSTENEDIONE","code_information":[{"code":"3000083","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":339.0,"discounted_cash":203.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":291.0,"discounted_cash":174.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":274.0,"discounted_cash":164.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":113.0,"discounted_cash":67.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BILIRUBIN, TOTAL","code_information":[{"code":"3000090","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BILIRUBIN; DIRECT","code_information":[{"code":"3000091","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BLOOD, OCCULT,QUALITATIVE","code_information":[{"code":"3000093","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":118.0,"discounted_cash":70.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":95.0,"discounted_cash":57.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":87.0,"discounted_cash":52.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC QUALITATIVE FECAL BLOOD IMMUNOASSAY","code_information":[{"code":"3000096","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":95.0,"discounted_cash":57.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":201.0,"discounted_cash":120.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":188.0,"discounted_cash":112.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF VITAMIN D","code_information":[{"code":"3000098","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":127.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CALCIUM; TOTAL","code_information":[{"code":"3000100","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IONIZED CALCIUM","code_information":[{"code":"3000101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY, BLOOD CARBON DIOXIDE","code_information":[{"code":"3000106","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CARBON MONOXIDE, QUANTITATIVE","code_information":[{"code":"3000107","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":180.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":262.0,"discounted_cash":157.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA)","code_information":[{"code":"3000108","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CHLORIDE; BLOOD","code_information":[{"code":"3000115","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF URINE CHLORIDE","code_information":[{"code":"3000116","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CHLORIDE; FLUID","code_information":[{"code":"3000117","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":206.0,"discounted_cash":123.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CHOLESTEROL, SERUM, TOTAL","code_information":[{"code":"3000119","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO PSEUDOCHOLINESTERASE, TOTAL; PCHES","code_information":[{"code":"3000120","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82480","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":246.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC TOTAL CORTISOL","code_information":[{"code":"3000132","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":460.0,"discounted_cash":276.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":435.0,"discounted_cash":261.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CREATINE KINASE (CPK); TOTAL","code_information":[{"code":"3000136","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":192.0,"discounted_cash":115.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":179.0,"discounted_cash":107.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CREATININE; BLOOD","code_information":[{"code":"3000139","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CREATININE, OTHER SOURCE","code_information":[{"code":"3000140","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":73.0,"discounted_cash":43.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CREATININE CLEARANCE TEST","code_information":[{"code":"3000141","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":241.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":439.0,"discounted_cash":263.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":425.0,"discounted_cash":255.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CYANOCOBALAMIN (VITAMIN B-12)","code_information":[{"code":"3000145","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PED PROF DEOXYCORTISOL","code_information":[{"code":"3000150","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":339.0,"discounted_cash":203.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ERYTHROPOIETIN EPO","code_information":[{"code":"3000161","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"3000162","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.0,"discounted_cash":253.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":131.0,"discounted_cash":78.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":128.0,"discounted_cash":76.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FAT/LIPIDS FECES QUAL","code_information":[{"code":"3000168","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FERRITIN","code_information":[{"code":"3000172","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":165.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FETAL FIBRONECTIN, SEMI-QUANT","code_information":[{"code":"3000173","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":1348.0,"discounted_cash":808.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1158.0,"discounted_cash":694.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FOLIC ACID; SERUM","code_information":[{"code":"3000174","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":231.0,"discounted_cash":138.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":257.0,"discounted_cash":154.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":300.0,"discounted_cash":180.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BLOOD PH","code_information":[{"code":"3000182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":192.0,"discounted_cash":115.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":499.0,"discounted_cash":299.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":456.0,"discounted_cash":273.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":571.0,"discounted_cash":342.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":522.0,"discounted_cash":313.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":247.0,"discounted_cash":148.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GLUCOSE; CSF, OTHER FLUID","code_information":[{"code":"3000189","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GLUCOSE; QUANT, BLOOD","code_information":[{"code":"3000190","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GLUCOSE; POST DOSE","code_information":[{"code":"3000192","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":128.0,"discounted_cash":76.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GLUCOSE TOLERANCE TEST","code_information":[{"code":"3000193","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":579.0,"discounted_cash":347.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":530.0,"discounted_cash":318.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":125.0,"discounted_cash":75.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":168.0,"discounted_cash":100.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GONADOTROPIN (FSH)","code_information":[{"code":"3000198","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":210.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GONADOTROPIN (LH)","code_information":[{"code":"3000199","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":227.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":257.0,"discounted_cash":154.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":241.0,"discounted_cash":144.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HAPTOGLOBIN; QUANTITATIVE","code_information":[{"code":"3000201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":303.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":464.0,"discounted_cash":278.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO COBALT QUANT COS","code_information":[{"code":"3000203","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":372.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":603.0,"discounted_cash":361.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"3000204","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.0,"discounted_cash":208.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":198.0,"discounted_cash":118.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEMOGLOBIN; GLYCOSYLATED","code_information":[{"code":"3000207","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"3000208","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":114.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PLASMA HEMOGLOBIN","code_information":[{"code":"3000209","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":108.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":166.0,"discounted_cash":99.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":379.0,"discounted_cash":227.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":60.0,"discounted_cash":36.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":38.0,"discounted_cash":22.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MMUNOGLOBULIN BINDING PROTEIN","code_information":[{"code":"3000221","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":304.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":425.0,"discounted_cash":255.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":335.0,"discounted_cash":201.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":324.0,"discounted_cash":194.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF INSULIN, FREE","code_information":[{"code":"3000224","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IRON","code_information":[{"code":"3000225","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":125.0,"discounted_cash":75.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IRON BINDING CAPACITY","code_information":[{"code":"3000226","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":146.0,"discounted_cash":87.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF LACTIC ACID","code_information":[{"code":"3000228","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":180.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":275.0,"discounted_cash":165.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LACTATE DEHYDROGENASE (LDH)","code_information":[{"code":"3000229","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":100.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF LDH ENZYMES","code_information":[{"code":"3000230","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":178.0,"discounted_cash":106.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LACTOFERRIN,FECAL,QUAL","code_information":[{"code":"3000231","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LEAD, BLOOD","code_information":[{"code":"3000232","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":268.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":407.0,"discounted_cash":244.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LIPASE","code_information":[{"code":"3000235","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.0,"discounted_cash":156.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LIPOPROTEIN, HDL CHOLESTEROL","code_information":[{"code":"3000240","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":100.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MAGNESIUM","code_information":[{"code":"3000243","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":276.0,"discounted_cash":165.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MASS SPECTROMETRY;QUANTITATIVE EA","code_information":[{"code":"3000245","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":292.0,"discounted_cash":175.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":282.0,"discounted_cash":169.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF MYOGLOBIN","code_information":[{"code":"3000254","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.0,"discounted_cash":142.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":244.0,"discounted_cash":146.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC NATRIURETIC PEPTIDE (BNP), NTPROBNP","code_information":[{"code":"3000255","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":419.0,"discounted_cash":251.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO NUCLEOTIDASE 5- F5NUL","code_information":[{"code":"3000277","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OSMOLALITY; BLOOD","code_information":[{"code":"3000283","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC OSMOLALITY; URINE","code_information":[{"code":"3000284","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":171.0,"discounted_cash":102.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PARATHORMONE","code_information":[{"code":"3000287","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":310.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":474.0,"discounted_cash":284.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":102.0,"discounted_cash":61.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CALPROTECTIN, FECAL","code_information":[{"code":"3000290","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":261.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PHOSPHATASE,PROSTATIC PACP","code_information":[{"code":"3000293","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PHOSPHATASE, ALKALINE","code_information":[{"code":"3000294","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":410.0,"discounted_cash":246.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":397.0,"discounted_cash":238.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PHOSPHORUS","code_information":[{"code":"3000298","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URINE PHOSPHORUS","code_information":[{"code":"3000299","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":180.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":182.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC POTASSIUM; SERUM","code_information":[{"code":"3000302","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF URINE POTASSIUM","code_information":[{"code":"3000303","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":100.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PREALBUMIN","code_information":[{"code":"3000304","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":279.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":424.0,"discounted_cash":254.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PROGESTERONE","code_information":[{"code":"3000307","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.0,"discounted_cash":355.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":182.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PROLACIN","code_information":[{"code":"3000308","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":271.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":242.0,"discounted_cash":145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LAB PSA TOTAL","code_information":[{"code":"3000311","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":243.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":242.0,"discounted_cash":145.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PROTEIN, TOTAL","code_information":[{"code":"3000313","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PROTEIN-URINE","code_information":[{"code":"3000314","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PROTEIN, OTHER","code_information":[{"code":"3000315","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":227.0,"discounted_cash":136.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":379.0,"discounted_cash":227.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":345.0,"discounted_cash":207.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST","code_information":[{"code":"3000320","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":661.0,"discounted_cash":396.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":604.0,"discounted_cash":362.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF VITAMIN B-6","code_information":[{"code":"3000323","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SODIUM; SERUM","code_information":[{"code":"3000333","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF URINE SODIUM","code_information":[{"code":"3000334","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":84.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":129.0,"discounted_cash":77.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":141.0,"discounted_cash":84.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":129.0,"discounted_cash":77.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SPECTROPHOTOMETRY, ANALYTE NOS","code_information":[{"code":"3000337","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BODY FLUID SPECIFIC GRAVITY","code_information":[{"code":"3000338","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84315","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":110.0,"discounted_cash":66.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":132.0,"discounted_cash":79.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF TOTAL TESTOSTERONE","code_information":[{"code":"3000343","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":478.0,"discounted_cash":286.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":478.0,"discounted_cash":286.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO THIOCYANATE; FTIO","code_information":[{"code":"3000345","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84430","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":225.0,"discounted_cash":135.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF TOTAL THYROXINE","code_information":[{"code":"3000347","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF FREE THYROXINE","code_information":[{"code":"3000348","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":195.0,"discounted_cash":117.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY THYROID STIM HORMONE","code_information":[{"code":"3000350","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":141.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF TRANSFERRIN","code_information":[{"code":"3000356","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"3000357","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO THYROID UPTAKE; FRTUP","code_information":[{"code":"3000358","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":276.0,"discounted_cash":165.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":253.0,"discounted_cash":151.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC TRIIODOTHYRONINE T3; FREE","code_information":[{"code":"3000360","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":205.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":311.0,"discounted_cash":186.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC TROPONIN, QUANTITATIVE","code_information":[{"code":"3000362","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":490.0,"discounted_cash":294.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":445.0,"discounted_cash":267.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF UREA NITROGEN","code_information":[{"code":"3000364","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":69.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URIC ACID; BLOOD","code_information":[{"code":"3000366","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF VOLATILES","code_information":[{"code":"3000374","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.0,"discounted_cash":459.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":583.0,"discounted_cash":349.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":419.0,"discounted_cash":251.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":384.0,"discounted_cash":230.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":252.0,"discounted_cash":151.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GONADOTROPIN, CHORIONIC (HCG), QUANT","code_information":[{"code":"3000378","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GONADOTROPIN, CHORIONIC (HCG), QUAL","code_information":[{"code":"3000379","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED CHEMISTRY PROCEDURE","code_information":[{"code":"3000380","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":102.0,"discounted_cash":61.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":108.0,"discounted_cash":64.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC RETICULOCYTE COUNT, AUTOMATED","code_information":[{"code":"3000391","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":128.0,"discounted_cash":76.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PLATELET; AUTOMATED COUNT","code_information":[{"code":"3000393","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":99.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":149.0,"discounted_cash":89.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1521.0,"discounted_cash":912.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":323.0,"discounted_cash":193.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":824.0,"discounted_cash":494.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":799.0,"discounted_cash":479.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":848.0,"discounted_cash":508.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":776.0,"discounted_cash":465.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":914.0,"discounted_cash":548.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":888.0,"discounted_cash":532.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":459.0,"discounted_cash":275.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":444.0,"discounted_cash":266.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":472.0,"discounted_cash":283.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":434.0,"discounted_cash":260.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":405.0,"discounted_cash":243.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":77.0,"discounted_cash":46.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FACTOR IX (PTC/CHRISTMAS)","code_information":[{"code":"3000402","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.0,"discounted_cash":291.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":444.0,"discounted_cash":266.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":920.0,"discounted_cash":552.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":894.0,"discounted_cash":536.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":860.0,"discounted_cash":516.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":833.0,"discounted_cash":499.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":637.0,"discounted_cash":382.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":616.0,"discounted_cash":369.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTITHROMBIN III, ACTIVITY","code_information":[{"code":"3000409","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":247.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":276.0,"discounted_cash":165.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":465.0,"discounted_cash":279.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":418.0,"discounted_cash":250.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":441.0,"discounted_cash":264.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":844.0,"discounted_cash":506.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":817.0,"discounted_cash":490.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1020.0,"discounted_cash":612.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":848.0,"discounted_cash":508.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC COAGULATION TIME;ACTIVATED","code_information":[{"code":"3000417","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":110.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":169.0,"discounted_cash":101.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC D-DIMER; QUANTITATIVE","code_information":[{"code":"3000421","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":352.0,"discounted_cash":211.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":321.0,"discounted_cash":192.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FIBRINOGEN; ACTIVITY","code_information":[{"code":"3000422","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":332.0,"discounted_cash":199.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":145.0,"discounted_cash":87.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":352.0,"discounted_cash":211.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":321.0,"discounted_cash":192.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEMOGLOBIN/RBCS, FETAL; ROSETTE","code_information":[{"code":"3000427","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":323.0,"discounted_cash":193.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PLATELET; AGGREGATION","code_information":[{"code":"3000433","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":300.0,"discounted_cash":180.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PROTHROMBIN TIME","code_information":[{"code":"3000435","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.0,"discounted_cash":109.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":119.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":244.0,"discounted_cash":146.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SEDIMENTATION RATE, ERYTHROCYT; NON-AUTO","code_information":[{"code":"3000438","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SEDIMENTATION RATE, ERYTHROCYTE; AUTO","code_information":[{"code":"3000439","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC RBC SICKLE CELL TEST","code_information":[{"code":"3000440","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC THROMBIN TIME; PLASMA","code_information":[{"code":"3000441","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.0,"discounted_cash":152.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":231.0,"discounted_cash":138.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC THROMBOPLASTIN TIME, PARTIAL (PTT)","code_information":[{"code":"3000442","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":285.0,"discounted_cash":171.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":275.0,"discounted_cash":165.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":947.0,"discounted_cash":568.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":919.0,"discounted_cash":551.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTINUCLEAR ANTIBODIES; TITER","code_information":[{"code":"3000453","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTISTREPTOLYSIN O; SCREEN","code_information":[{"code":"3000455","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":260.0,"discounted_cash":156.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC C-RE1 PROTEIN","code_information":[{"code":"3000457","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":109.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":168.0,"discounted_cash":100.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":330.0,"discounted_cash":198.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":302.0,"discounted_cash":181.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC CARDIOLIPIN ANTIBODY IGG","code_information":[{"code":"3000460","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":153.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":256.0,"discounted_cash":153.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":535.0,"discounted_cash":321.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":111.0,"discounted_cash":66.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC COLD AGGLUTININ, TITER","code_information":[{"code":"3000462","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86157","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":108.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":165.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":265.0,"discounted_cash":159.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO COMPLEMENT; FUNCTIONAL ACTIVITY","code_information":[{"code":"3000464","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.0,"discounted_cash":356.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":561.0,"discounted_cash":336.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":239.0,"discounted_cash":143.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":39.0,"discounted_cash":23.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":552.0,"discounted_cash":331.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":533.0,"discounted_cash":319.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ENA INITIAL LAB TEST","code_information":[{"code":"3000471","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":279.0,"discounted_cash":167.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":102.0,"discounted_cash":61.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":399.0,"discounted_cash":239.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":401.0,"discounted_cash":240.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOASSAY, TUMOR CA 125","code_information":[{"code":"3000477","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":219.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":335.0,"discounted_cash":201.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HETEROPHILE ANTIBODIES; SCREEN","code_information":[{"code":"3000478","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.0,"discounted_cash":123.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":413.0,"discounted_cash":247.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":375.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":413.0,"discounted_cash":247.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ISLET CELL ANTIBODY(SO)","code_information":[{"code":"3000489","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":348.0,"discounted_cash":208.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":275.0,"discounted_cash":165.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":265.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":327.0,"discounted_cash":196.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":276.0,"discounted_cash":165.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":291.0,"discounted_cash":174.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":459.0,"discounted_cash":275.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":531.0,"discounted_cash":318.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":113.0,"discounted_cash":67.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":297.0,"discounted_cash":178.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":247.0,"discounted_cash":148.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC RHEUMATOID FACTOR; QUALITATIVE","code_information":[{"code":"3000502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC RHEUMATOID FACTOR; QUANT","code_information":[{"code":"3000503","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":91.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":137.0,"discounted_cash":82.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":465.0,"discounted_cash":279.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":146.0,"discounted_cash":87.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":119.0,"discounted_cash":71.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":111.0,"discounted_cash":66.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":91.0,"discounted_cash":54.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":444.0,"discounted_cash":266.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":419.0,"discounted_cash":251.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":206.0,"discounted_cash":123.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY, BORDETELLA","code_information":[{"code":"3000512","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":436.0,"discounted_cash":261.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":422.0,"discounted_cash":253.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":180.0,"discounted_cash":108.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":298.0,"discounted_cash":178.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTIBODY; DIPHTHERIA DIPGS","code_information":[{"code":"3000525","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86648","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":231.0,"discounted_cash":138.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":231.0,"discounted_cash":138.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":339.0,"discounted_cash":203.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":274.0,"discounted_cash":164.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; HEPATITIS, DELTA AGENT","code_information":[{"code":"3000542","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":305.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":466.0,"discounted_cash":279.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":207.0,"discounted_cash":124.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":220.0,"discounted_cash":132.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":220.0,"discounted_cash":132.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":173.0,"discounted_cash":103.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; HIV-1","code_information":[{"code":"3000547","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; HIV-1 & HIV-2, SINGLE","code_information":[{"code":"3000548","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86703","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":221.0,"discounted_cash":132.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEPATITIS B CORE, IGM","code_information":[{"code":"3000550","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":209.0,"discounted_cash":125.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":189.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEPATITIS A ANTIBODY; IGM","code_information":[{"code":"3000554","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; LEPTOSPIRA","code_information":[{"code":"3000557","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":182.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MUMPS AB","code_information":[{"code":"3000559","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.0,"discounted_cash":118.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":276.0,"discounted_cash":165.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":130.0,"discounted_cash":78.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":298.0,"discounted_cash":178.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTIBODY; TETANUS TTIGS","code_information":[{"code":"3000570","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":64.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":102.0,"discounted_cash":61.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":277.0,"discounted_cash":166.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":231.0,"discounted_cash":138.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":298.0,"discounted_cash":178.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":468.0,"discounted_cash":280.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":455.0,"discounted_cash":273.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":392.0,"discounted_cash":235.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":381.0,"discounted_cash":228.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":491.0,"discounted_cash":294.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":424.0,"discounted_cash":254.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY ELUTION","code_information":[{"code":"3000586","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":206.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":296.0,"discounted_cash":177.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":478.0,"discounted_cash":286.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":492.0,"discounted_cash":295.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; DIRECT","code_information":[{"code":"3000588","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; INDIRECT","code_information":[{"code":"3000589","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.0,"discounted_cash":145.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":221.0,"discounted_cash":132.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; INDIRECT, TITER","code_information":[{"code":"3000590","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.0,"discounted_cash":330.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":502.0,"discounted_cash":301.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BLOOD TYPING; ABO","code_information":[{"code":"3000592","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":154.0,"discounted_cash":92.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BLOOD TYPING; RH (D)","code_information":[{"code":"3000593","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":97.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":72.0,"discounted_cash":43.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":254.0,"discounted_cash":152.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":198.0,"discounted_cash":118.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":567.0,"discounted_cash":340.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":467.0,"discounted_cash":280.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":356.0,"discounted_cash":213.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CONCENTRATION, FOR INFECTIOUS AGENTS","code_information":[{"code":"3000611","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":405.0,"discounted_cash":243.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":370.0,"discounted_cash":222.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE; STOOL","code_information":[{"code":"3000613","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":176.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":182.0,"discounted_cash":109.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE; STOOL, ADDL PATHOGENS","code_information":[{"code":"3000614","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":37.0,"discounted_cash":22.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, BACTERIA, OTHER","code_information":[{"code":"3000615","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":262.0,"discounted_cash":157.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, BACTERIA; QUANTITATIVE, AEROBIC","code_information":[{"code":"3000616","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":332.0,"discounted_cash":199.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, BACTERIA; QUANT, ANAEROBIC","code_information":[{"code":"3000617","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87073","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":332.0,"discounted_cash":199.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, ANAEROBIC","code_information":[{"code":"3000618","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":198.0,"discounted_cash":118.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":181.0,"discounted_cash":108.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":105.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, SCREENING ONLY","code_information":[{"code":"3000621","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":98.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":114.0,"discounted_cash":68.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":114.0,"discounted_cash":68.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":208.0,"discounted_cash":124.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":162.0,"discounted_cash":97.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":278.0,"discounted_cash":166.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, FUNGI, BLOOD","code_information":[{"code":"3000626","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":275.0,"discounted_cash":165.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":183.0,"discounted_cash":109.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":178.0,"discounted_cash":106.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, DEFINITIVE ID, MOLD","code_information":[{"code":"3000628","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":179.0,"discounted_cash":107.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, MYCOBACTERIA","code_information":[{"code":"3000631","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.0,"discounted_cash":243.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE TYPING; IMMUNOLOGIC METHOD","code_information":[{"code":"3000634","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":66.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":100.0,"discounted_cash":60.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MACROSCOPIC EXAM; ARTHROPOD","code_information":[{"code":"3000637","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":160.0,"discounted_cash":96.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MACROSCOPIC EXAM; PARASITE","code_information":[{"code":"3000638","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":87.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":107.0,"discounted_cash":64.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PINWORM EXAM","code_information":[{"code":"3000639","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87172","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":162.0,"discounted_cash":97.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HOMOGENIZATION, TISSUE, FOR CULTURE","code_information":[{"code":"3000640","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":110.0,"discounted_cash":66.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":237.0,"discounted_cash":142.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SUSCEPTABILITY STUDIES, AGAR DILUTION","code_information":[{"code":"3000642","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":101.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":47.0,"discounted_cash":28.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SUSCEPTIBILITY STUDIES, DISK METHOD","code_information":[{"code":"3000643","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SUSCEPTIBILITY STUDIES, ENZYME DETECTION","code_information":[{"code":"3000644","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SUSCEPTIBILITY STUDIES, MICRODILUTION","code_information":[{"code":"3000645","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":118.0,"discounted_cash":70.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SMEAR, GRAM / GIEMSA STAIN","code_information":[{"code":"3000647","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SMEAR, MODIFIED ACID FAST","code_information":[{"code":"3000648","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":162.0,"discounted_cash":97.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SMEAR, INCLUSION BODIES, PARASITES","code_information":[{"code":"3000649","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":124.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":188.0,"discounted_cash":112.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SMEAR, WET MOUNT","code_information":[{"code":"3000651","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":164.0,"discounted_cash":98.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC KOH TISSUE EXAMINATION","code_information":[{"code":"3000652","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":164.0,"discounted_cash":98.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":490.0,"discounted_cash":294.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":301.0,"discounted_cash":180.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":292.0,"discounted_cash":175.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":361.0,"discounted_cash":216.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":330.0,"discounted_cash":198.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":356.0,"discounted_cash":213.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":395.0,"discounted_cash":237.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CHLAMYDIA TRACHOMATIS, ANTIGEN, EIA","code_information":[{"code":"3000667","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87320","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":151.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CLOSTRIDIUM DIFFICILE TOXINS","code_information":[{"code":"3000668","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":282.0,"discounted_cash":169.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CRYTOSPORIDUM/GIARDIA, AG EIA","code_information":[{"code":"3000670","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":113.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":173.0,"discounted_cash":103.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GIARDIA AG, EIA","code_information":[{"code":"3000671","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":93.0,"discounted_cash":55.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":399.0,"discounted_cash":239.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":183.0,"discounted_cash":109.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":422.0,"discounted_cash":253.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":183.0,"discounted_cash":109.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO HISTOPLASMA CAPSULATUM FMVHU","code_information":[{"code":"3000679","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":546.0,"discounted_cash":327.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":514.0,"discounted_cash":308.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ROTAVIRUS, ANTIGEN, EIA","code_information":[{"code":"3000681","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.0,"discounted_cash":207.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":315.0,"discounted_cash":189.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":184.0,"discounted_cash":110.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":75.0,"discounted_cash":45.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":399.0,"discounted_cash":239.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":578.0,"discounted_cash":346.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":563.0,"discounted_cash":337.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":265.0,"discounted_cash":159.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":643.0,"discounted_cash":385.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":623.0,"discounted_cash":373.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ENTEROVIRUS,AMPL PROBE TECHNIQUE","code_information":[{"code":"3000693","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.0,"discounted_cash":274.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":503.0,"discounted_cash":301.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":865.0,"discounted_cash":519.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":840.0,"discounted_cash":504.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":821.0,"discounted_cash":492.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":795.0,"discounted_cash":477.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":579.0,"discounted_cash":347.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":564.0,"discounted_cash":338.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":569.0,"discounted_cash":341.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":553.0,"discounted_cash":331.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":262.0,"discounted_cash":157.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":384.0,"discounted_cash":230.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":547.0,"discounted_cash":328.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":529.0,"discounted_cash":317.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":293.0,"discounted_cash":175.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":404.0,"discounted_cash":242.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":308.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":192.0,"discounted_cash":115.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":190.0,"discounted_cash":114.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":75.0,"discounted_cash":45.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1416.0,"discounted_cash":849.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1333.0,"discounted_cash":799.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":378.0,"discounted_cash":226.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":369.0,"discounted_cash":221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":337.0,"discounted_cash":202.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FLUID, CRYSTALS (BODY)","code_information":[{"code":"3000735","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC NASAL SMEAR, EOSINOPHILS","code_information":[{"code":"3000738","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89190","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":107.0,"discounted_cash":64.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC LAB SWEAT COLL IONTOPHORESIS LAB TEST","code_information":[{"code":"3000740","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89230","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":127.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":206.0,"discounted_cash":123.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC TRAVEL ALLOWANCE-1","code_information":[{"code":"3000742","type":"CDM"},{"code":"0300","type":"RC"},{"code":"99001","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":6.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":7.0,"discounted_cash":4.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PHLEBOTOMY, THERAPEUTIC LAB","code_information":[{"code":"3000744","type":"CDM"},{"code":"0940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":643.0,"discounted_cash":385.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC PSA, SCREENING","code_information":[{"code":"3000747","type":"CDM"},{"code":"0300","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":251.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":72.0,"discounted_cash":43.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":72.0,"discounted_cash":43.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":183.0,"discounted_cash":109.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":72.0,"discounted_cash":43.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC PROCALCITONIN LAB TEST","code_information":[{"code":"3000757","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":265.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":408.0,"discounted_cash":244.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":749.0,"discounted_cash":449.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":703.0,"discounted_cash":421.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":785.0,"discounted_cash":471.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":719.0,"discounted_cash":431.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":413.0,"discounted_cash":247.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":377.0,"discounted_cash":226.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":274.0,"discounted_cash":164.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC INFL VIR MULT TYPES AMP PROB BYOND 2 EA","code_information":[{"code":"3000792","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87503","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":48.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":506.0,"discounted_cash":303.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":491.0,"discounted_cash":294.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":173.0,"discounted_cash":103.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":379.0,"discounted_cash":227.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  QUANTITATIVE ASSAY, DRUG","code_information":[{"code":"3000830","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":234.0,"discounted_cash":140.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":137.0,"discounted_cash":82.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":198.0,"discounted_cash":118.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":181.0,"discounted_cash":108.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":328.0,"discounted_cash":196.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":252.0,"discounted_cash":151.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":228.0,"discounted_cash":136.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":262.0,"discounted_cash":157.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":125.0,"discounted_cash":75.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":113.0,"discounted_cash":67.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":213.0,"discounted_cash":127.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":60.0,"discounted_cash":36.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":62.0,"discounted_cash":37.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":38.0,"discounted_cash":22.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":508.0,"discounted_cash":304.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":425.0,"discounted_cash":255.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":345.0,"discounted_cash":207.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":324.0,"discounted_cash":194.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":752.0,"discounted_cash":451.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":689.0,"discounted_cash":413.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1111.0,"discounted_cash":666.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":1016.0,"discounted_cash":609.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":253.0,"discounted_cash":151.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":229.0,"discounted_cash":137.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":393.0,"discounted_cash":235.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":383.0,"discounted_cash":229.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":351.0,"discounted_cash":210.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":320.0,"discounted_cash":192.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":325.0,"discounted_cash":195.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":148.0,"discounted_cash":88.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"}]},{"description":"HC  PLATELET; AGGREGATION","code_information":[{"code":"3000883","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":707.0,"discounted_cash":424.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":242.0,"discounted_cash":145.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":242.0,"discounted_cash":145.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":535.0,"discounted_cash":321.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":111.0,"discounted_cash":66.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":252.0,"discounted_cash":151.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":252.0,"discounted_cash":151.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":266.0,"discounted_cash":159.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":229.0,"discounted_cash":137.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":39.0,"discounted_cash":23.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":37.0,"discounted_cash":22.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":164.0,"discounted_cash":98.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":260.0,"discounted_cash":156.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":282.0,"discounted_cash":169.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":265.0,"discounted_cash":159.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":177.0,"discounted_cash":106.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":166.0,"discounted_cash":99.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":153.0,"discounted_cash":91.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":73.0,"discounted_cash":43.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  ANTIBODY; ENCEPHALITIS, ST. LOUIS","code_information":[{"code":"3000905","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":277.0,"discounted_cash":166.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":281.0,"discounted_cash":168.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":698.0,"discounted_cash":418.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":639.0,"discounted_cash":383.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":81.0,"discounted_cash":48.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":81.0,"discounted_cash":48.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":215.0,"discounted_cash":129.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":179.0,"discounted_cash":107.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":173.0,"discounted_cash":103.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":369.0,"discounted_cash":221.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":141.0,"discounted_cash":84.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":129.0,"discounted_cash":77.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  MICROALBUMIN, QUANTITATIVE","code_information":[{"code":"3000922","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":61.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":103.0,"discounted_cash":61.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  IONIZED CALCIUM","code_information":[{"code":"3000923","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  CREATINE KINASE (CPK); TOTAL","code_information":[{"code":"3000925","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC IGE LAB TEST","code_information":[{"code":"3000926","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":180.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":571.0,"discounted_cash":342.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":522.0,"discounted_cash":313.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  BLOOD METHEMOGLOBIN ASSAY","code_information":[{"code":"3000928","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":114.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":225.0,"discounted_cash":135.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":60.0,"discounted_cash":36.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  ASSAY OF LACTIC ACID","code_information":[{"code":"3000930","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.0,"discounted_cash":180.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":275.0,"discounted_cash":165.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  LACTATE DEHYDROGENASE (LDH)","code_information":[{"code":"3000931","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":167.0,"discounted_cash":100.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":152.0,"discounted_cash":91.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":276.0,"discounted_cash":165.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":257.0,"discounted_cash":154.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":393.0,"discounted_cash":235.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":383.0,"discounted_cash":229.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  PARATHORMONE","code_information":[{"code":"3000935","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":518.0,"discounted_cash":310.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":474.0,"discounted_cash":284.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  ASSAY OF PROTEIN-URINE","code_information":[{"code":"3000936","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  PROTHROMBIN TIME","code_information":[{"code":"3000938","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.0,"discounted_cash":39.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":119.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  PROTHROMBIN TIME","code_information":[{"code":"3000939","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.0,"discounted_cash":145.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":119.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO COMPLEMENT; C1Q","code_information":[{"code":"3000940","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":222.0,"discounted_cash":133.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  NUCLEAR ANTIGEN  ANTIBODY","code_information":[{"code":"3000942","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":213.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":326.0,"discounted_cash":195.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":252.0,"discounted_cash":151.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":107.0,"discounted_cash":64.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":399.0,"discounted_cash":239.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":387.0,"discounted_cash":232.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  ANTIBODY; CYTOMEGALOVIRUS","code_information":[{"code":"3000946","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  ANTIBODY; CYTOMEGALOVIRUS, IGM","code_information":[{"code":"3000947","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":262.0,"discounted_cash":157.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":207.0,"discounted_cash":124.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":207.0,"discounted_cash":124.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC  BLOOD TYPING; ABO","code_information":[{"code":"3000953","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  BLOOD TYPING; ABO","code_information":[{"code":"3000954","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":175.0,"discounted_cash":105.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC  CULTURE; STOOL, ADDL PATHOGENS","code_information":[{"code":"3000958","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  CULTURE, BACTERIA, OTHER","code_information":[{"code":"3000959","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":356.0,"discounted_cash":213.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":326.0,"discounted_cash":195.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":105.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  CULTURE, SCREENING ONLY","code_information":[{"code":"3000961","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":100.0,"discounted_cash":60.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  CULTURE, DEFINITIVE ID, YEAST","code_information":[{"code":"3000963","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":178.0,"discounted_cash":106.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  CULTURE TYPING; IMMUNOLOGIC METHOD","code_information":[{"code":"3000964","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":66.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":100.0,"discounted_cash":60.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  CULTURE TYPING; IMMUNOLOGIC METHOD","code_information":[{"code":"3000965","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":66.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":100.0,"discounted_cash":60.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  SUSCEPTIBILITY STUDIES, DISK METHOD","code_information":[{"code":"3000967","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":72.0,"discounted_cash":43.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  SMEAR, GRAM / GIEMSA STAIN","code_information":[{"code":"3000969","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  SMEAR, WET MOUNT","code_information":[{"code":"3000970","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":164.0,"discounted_cash":98.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":320.0,"discounted_cash":192.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":292.0,"discounted_cash":175.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  ANTIBODY;LYMPHOCYT CHORIOMENINGITIS","code_information":[{"code":"3000973","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":63.0,"discounted_cash":37.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":217.0,"discounted_cash":130.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":227.0,"discounted_cash":136.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":197.0,"discounted_cash":118.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":247.0,"discounted_cash":148.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":232.0,"discounted_cash":139.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":276.0,"discounted_cash":165.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":81.0,"discounted_cash":48.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":147.0,"discounted_cash":88.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":137.0,"discounted_cash":82.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":121.0,"discounted_cash":72.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":47.0,"discounted_cash":28.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":663.0,"discounted_cash":397.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":606.0,"discounted_cash":363.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":547.0,"discounted_cash":328.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":529.0,"discounted_cash":317.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":241.0,"discounted_cash":144.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":220.0,"discounted_cash":132.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":378.0,"discounted_cash":226.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":457.0,"discounted_cash":274.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":419.0,"discounted_cash":251.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY, CARBAMAZEPINE, TOTAL","code_information":[{"code":"3000994","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF ETHOSUXIMIDE","code_information":[{"code":"3000996","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":262.0,"discounted_cash":157.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF LIDOCAINE","code_information":[{"code":"3000997","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PHENOBARBITAL","code_information":[{"code":"3000999","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PHENYTOIN, FREE","code_information":[{"code":"3001000","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":207.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":313.0,"discounted_cash":187.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PRIMIDONE","code_information":[{"code":"3001001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":205.0,"discounted_cash":123.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":255.0,"discounted_cash":153.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":660.0,"discounted_cash":396.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":604.0,"discounted_cash":362.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":431.0,"discounted_cash":258.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":418.0,"discounted_cash":250.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":508.0,"discounted_cash":304.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":479.0,"discounted_cash":287.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":169.0,"discounted_cash":101.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":160.0,"discounted_cash":96.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":491.0,"discounted_cash":294.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":462.0,"discounted_cash":277.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":297.0,"discounted_cash":178.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":278.0,"discounted_cash":166.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ALPHA-1 ANTITRYPSIN; PHENOTYPE","code_information":[{"code":"3001010","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":255.0,"discounted_cash":153.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ALUMINUM; AL","code_information":[{"code":"3001013","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":157.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":245.0,"discounted_cash":147.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1002.0,"discounted_cash":601.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":917.0,"discounted_cash":550.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC AMINO ACIDS, SINGLE QUANT","code_information":[{"code":"3001015","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1239.0,"discounted_cash":743.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":393.0,"discounted_cash":235.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":370.0,"discounted_cash":222.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":677.0,"discounted_cash":406.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANDROSTENEDIONE; ANST","code_information":[{"code":"3001018","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":340.0,"discounted_cash":204.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST","code_information":[{"code":"3001019","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":251.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":384.0,"discounted_cash":230.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":237.0,"discounted_cash":142.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":228.0,"discounted_cash":136.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":168.0,"discounted_cash":100.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ARSENIC BLOOD ASB","code_information":[{"code":"3001022","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":404.0,"discounted_cash":242.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":381.0,"discounted_cash":228.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":837.0,"discounted_cash":502.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":811.0,"discounted_cash":486.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":551.0,"discounted_cash":330.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":503.0,"discounted_cash":301.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO BIOTINIDASE,EACH BIOTS","code_information":[{"code":"3001027","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82261","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":188.0,"discounted_cash":112.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CALCITONIN CATN","code_information":[{"code":"3001029","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":225.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":352.0,"discounted_cash":211.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CALCIUM; TOTAL","code_information":[{"code":"3001030","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IONIZED CALCIUM","code_information":[{"code":"3001031","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":285.0,"discounted_cash":171.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":148.0,"discounted_cash":88.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":134.0,"discounted_cash":80.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":204.0,"discounted_cash":122.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":394.0,"discounted_cash":236.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":372.0,"discounted_cash":223.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":383.0,"discounted_cash":229.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":358.0,"discounted_cash":214.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO CATECHOLAMINES; URINE; CATU","code_information":[{"code":"3001036","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":226.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":354.0,"discounted_cash":212.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO CHEMILUMINESCENT ASSAY; PTHRP","code_information":[{"code":"3001037","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":150.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":233.0,"discounted_cash":139.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF URINE CHLORIDE","code_information":[{"code":"3001038","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO CHOLINESTERASE, RBC; ACHS","code_information":[{"code":"3001039","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82482","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":202.0,"discounted_cash":121.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO CHROMIUM; CRS","code_information":[{"code":"3001041","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":335.0,"discounted_cash":201.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":324.0,"discounted_cash":194.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":301.0,"discounted_cash":180.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":282.0,"discounted_cash":169.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":205.0,"discounted_cash":123.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO CORTISOL, FREE; CORTU","code_information":[{"code":"3001046","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO TOTAL CORTISOL; SALCT","code_information":[{"code":"3001047","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":648.0,"discounted_cash":388.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":593.0,"discounted_cash":355.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CREATININE, OTHER SOURCE","code_information":[{"code":"3001052","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":73.0,"discounted_cash":43.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":514.0,"discounted_cash":308.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":482.0,"discounted_cash":289.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":892.0,"discounted_cash":535.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":840.0,"discounted_cash":504.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":74.0,"discounted_cash":44.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ASSAY OF ESTRADIOL","code_information":[{"code":"3001059","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":244.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":306.0,"discounted_cash":183.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ESTRIOL; UE3","code_information":[{"code":"3001060","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ESTRONE; E1","code_information":[{"code":"3001061","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ETHYLENE GLYCOL","code_information":[{"code":"3001062","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.0,"discounted_cash":288.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1020.0,"discounted_cash":612.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":960.0,"discounted_cash":576.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":802.0,"discounted_cash":481.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":733.0,"discounted_cash":439.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":413.0,"discounted_cash":247.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":377.0,"discounted_cash":226.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO GASTRIN; GAST","code_information":[{"code":"3001068","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.0,"discounted_cash":158.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GLUCOSE; QUANT, BLOOD","code_information":[{"code":"3001069","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":75.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":113.0,"discounted_cash":67.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":166.0,"discounted_cash":99.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":164.0,"discounted_cash":98.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO HEMOGLOBIN; GLYCOSYLATED; HBA1C","code_information":[{"code":"3001072","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":116.0,"discounted_cash":69.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":553.0,"discounted_cash":331.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HOMOCYSTINE; HCYSU","code_information":[{"code":"3001074","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":234.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":369.0,"discounted_cash":221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":227.0,"discounted_cash":136.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":330.0,"discounted_cash":198.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":310.0,"discounted_cash":186.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":239.0,"discounted_cash":143.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4758.0,"discounted_cash":2854.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4355.0,"discounted_cash":2613.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1491.0,"discounted_cash":894.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1363.0,"discounted_cash":817.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOGLOBULIN BINDING PROTEIN","code_information":[{"code":"3001081","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":621.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":948.0,"discounted_cash":568.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001082","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.0,"discounted_cash":340.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":518.0,"discounted_cash":310.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001083","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1410.0,"discounted_cash":846.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1290.0,"discounted_cash":774.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LEAD, BLOOD","code_information":[{"code":"3001084","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.0,"discounted_cash":103.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":158.0,"discounted_cash":94.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LIPOPROTIEN ASSOC PHOSPHLIPASE A2","code_information":[{"code":"3001085","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":679.0,"discounted_cash":407.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":619.0,"discounted_cash":371.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":372.0,"discounted_cash":223.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":339.0,"discounted_cash":203.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC LIPOPROTEIN, HDL CHOLESTEROL","code_information":[{"code":"3001087","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":100.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MASS SPECTROMETRY;QUANTITATIVE EA","code_information":[{"code":"3001089","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":99.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":149.0,"discounted_cash":89.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MASS SPECTROMETRY;QUANTITATIVE EA","code_information":[{"code":"3001090","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF MERCURY","code_information":[{"code":"3001091","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":192.0,"discounted_cash":115.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC METANEPHRINES","code_information":[{"code":"3001092","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":374.0,"discounted_cash":224.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MUCOPOLYSACCHARIDES QUANT","code_information":[{"code":"3001095","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":309.0,"discounted_cash":185.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":281.0,"discounted_cash":168.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MUCOPOLYSACCHARIDES QUANT","code_information":[{"code":"3001096","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":414.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":631.0,"discounted_cash":378.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":426.0,"discounted_cash":255.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":402.0,"discounted_cash":241.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ORGANIC ACIDS,QUALITATIVE","code_information":[{"code":"3001124","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":450.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":686.0,"discounted_cash":411.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":385.0,"discounted_cash":231.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC OXALATE","code_information":[{"code":"3001127","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":216.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":330.0,"discounted_cash":198.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO PHENCYCLIDINE FPHNC","code_information":[{"code":"3001128","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83992","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":473.0,"discounted_cash":283.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CALPROTECTIN, FECAL","code_information":[{"code":"3001129","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.0,"discounted_cash":589.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":954.0,"discounted_cash":572.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PHENYLALANINE (PKU) BLOOD","code_information":[{"code":"3001131","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO PHOSPHATASE, ALKALINE ALKI","code_information":[{"code":"3001132","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":73.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":115.0,"discounted_cash":69.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":205.0,"discounted_cash":123.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PHOSPHORUS","code_information":[{"code":"3001134","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":125.0,"discounted_cash":75.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC URINE PHOSPHORUS","code_information":[{"code":"3001135","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":81.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":125.0,"discounted_cash":75.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO PORPHOBILINOGEN, URINE; PBGU","code_information":[{"code":"3001136","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO PORPHOBILINOGEN, URINE; PQNU","code_information":[{"code":"3001137","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.0,"discounted_cash":112.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":177.0,"discounted_cash":106.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":252.0,"discounted_cash":151.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC POTASSIUM; SERUM","code_information":[{"code":"3001139","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":118.0,"discounted_cash":70.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO PREGNENOLONE; PREGN","code_information":[{"code":"3001140","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.0,"discounted_cash":358.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":565.0,"discounted_cash":339.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PREGNANCY ASSOC PLASMA PROT","code_information":[{"code":"3001141","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84163","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":220.0,"discounted_cash":132.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":390.0,"discounted_cash":234.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":631.0,"discounted_cash":378.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":594.0,"discounted_cash":356.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":622.0,"discounted_cash":373.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":604.0,"discounted_cash":362.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST","code_information":[{"code":"3001145","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":564.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":860.0,"discounted_cash":516.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST","code_information":[{"code":"3001146","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1424.0,"discounted_cash":854.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1302.0,"discounted_cash":781.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":555.0,"discounted_cash":333.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":522.0,"discounted_cash":313.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":342.0,"discounted_cash":205.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":321.0,"discounted_cash":192.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":721.0,"discounted_cash":432.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":679.0,"discounted_cash":407.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":242.0,"discounted_cash":145.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":242.0,"discounted_cash":145.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":445.0,"discounted_cash":267.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":420.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":323.0,"discounted_cash":193.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":303.0,"discounted_cash":181.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":346.0,"discounted_cash":207.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":326.0,"discounted_cash":195.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":270.0,"discounted_cash":162.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":453.0,"discounted_cash":271.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":425.0,"discounted_cash":255.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":209.0,"discounted_cash":125.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SODIUM; SERUM","code_information":[{"code":"3001158","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.0,"discounted_cash":69.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":104.0,"discounted_cash":62.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":389.0,"discounted_cash":233.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":192.0,"discounted_cash":115.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SULFATE, URINE","code_information":[{"code":"3001161","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":107.0,"discounted_cash":64.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":298.0,"discounted_cash":178.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":290.0,"discounted_cash":174.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF THIOCYANATE","code_information":[{"code":"3001164","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84430","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":163.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":247.0,"discounted_cash":148.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":216.0,"discounted_cash":129.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":204.0,"discounted_cash":122.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":607.0,"discounted_cash":364.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":571.0,"discounted_cash":342.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":218.0,"discounted_cash":130.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":206.0,"discounted_cash":123.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":196.0,"discounted_cash":117.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":179.0,"discounted_cash":107.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO TYROSINE BLOOD; PKU","code_information":[{"code":"3001170","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84510","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":136.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":263.0,"discounted_cash":157.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":247.0,"discounted_cash":148.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":531.0,"discounted_cash":318.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":501.0,"discounted_cash":300.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO VITAMIN A; VITA","code_information":[{"code":"3001174","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":450.0,"discounted_cash":270.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":181.0,"discounted_cash":108.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":171.0,"discounted_cash":102.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC GONADOTROPIN, CHORIONIC (HCG), QUANT","code_information":[{"code":"3001177","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":229.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":350.0,"discounted_cash":210.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":94.0,"discounted_cash":56.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":750.0,"discounted_cash":450.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":686.0,"discounted_cash":411.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":486.0,"discounted_cash":291.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":444.0,"discounted_cash":266.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FACTOR XIII, FIBRIN STABILIZING","code_information":[{"code":"3001181","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85290","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":519.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":791.0,"discounted_cash":474.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FACTOR XIII,SCREEN INHIBITOR","code_information":[{"code":"3001182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":322.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":492.0,"discounted_cash":295.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":308.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":389.0,"discounted_cash":233.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":377.0,"discounted_cash":226.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":447.0,"discounted_cash":268.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":435.0,"discounted_cash":261.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":418.0,"discounted_cash":250.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FACTOR INHIBITOR TEST","code_information":[{"code":"3001187","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1412.0,"discounted_cash":847.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1292.0,"discounted_cash":775.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PLASMINOGEN ACTIVATOR","code_information":[{"code":"3001190","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":621.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":948.0,"discounted_cash":568.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO FIBRINOLYTIC PLASMINOGEN; PSGN","code_information":[{"code":"3001191","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":234.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO MURAMIDASE-LYSOZYME; MUR","code_information":[{"code":"3001192","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":387.0,"discounted_cash":232.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ALLERGEN SPECIFIC  IGE","code_information":[{"code":"3001195","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":61.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":401.0,"discounted_cash":240.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":377.0,"discounted_cash":226.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":528.0,"discounted_cash":316.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1687.0,"discounted_cash":1012.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1589.0,"discounted_cash":953.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTISTREPTOLYSIN; TITER; SABP","code_information":[{"code":"3001199","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":132.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":308.0,"discounted_cash":184.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO DEOXYRIBONUCLEASE, ANTIBODY; SABP","code_information":[{"code":"3001201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86215","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":108.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":171.0,"discounted_cash":102.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":289.0,"discounted_cash":173.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":272.0,"discounted_cash":163.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FLUORESCENT ANTIBODY, TITER","code_information":[{"code":"3001204","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":389.0,"discounted_cash":233.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":365.0,"discounted_cash":219.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":586.0,"discounted_cash":351.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":552.0,"discounted_cash":331.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":269.0,"discounted_cash":161.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":302.0,"discounted_cash":181.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":785.0,"discounted_cash":471.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":741.0,"discounted_cash":444.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO INHIBIN A; INHA","code_information":[{"code":"3001210","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":306.0,"discounted_cash":183.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":228.0,"discounted_cash":136.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":216.0,"discounted_cash":129.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":992.0,"discounted_cash":595.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":936.0,"discounted_cash":561.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY, ADENOVIRUS","code_information":[{"code":"3001214","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86603","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":127.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; ASPERGILLUS","code_information":[{"code":"3001215","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":113.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":173.0,"discounted_cash":103.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; CRYPTOCOCCUS","code_information":[{"code":"3001216","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86641","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":239.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":362.0,"discounted_cash":217.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; CYTOMEGALOVIRUS","code_information":[{"code":"3001217","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; CYTOMEGALOVIRUS, IGM","code_information":[{"code":"3001218","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; DIPHTHERIA","code_information":[{"code":"3001219","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86648","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":231.0,"discounted_cash":138.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY, ENTEROVIRUS","code_information":[{"code":"3001220","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTIBODY, EHRLICHIA; EHRC","code_information":[{"code":"3001221","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; HELICOBACTER PYLORI","code_information":[{"code":"3001222","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":216.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":274.0,"discounted_cash":164.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":345.0,"discounted_cash":207.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":313.0,"discounted_cash":187.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":679.0,"discounted_cash":407.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":639.0,"discounted_cash":383.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":216.0,"discounted_cash":129.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":204.0,"discounted_cash":122.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":57.0,"discounted_cash":34.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":57.0,"discounted_cash":34.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEPATITIS A ANTIBODY; TOTAL","code_information":[{"code":"3001228","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.0,"discounted_cash":132.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; INFLUENZA VIRUS","code_information":[{"code":"3001229","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86710","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTIBODY; LEGIONELLA LEGPA","code_information":[{"code":"3001230","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86713","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY;LYMPHOCYT CHORIOMENINGITIS","code_information":[{"code":"3001231","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86727","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":63.0,"discounted_cash":37.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":61.0,"discounted_cash":36.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":198.0,"discounted_cash":118.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":191.0,"discounted_cash":114.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTIBODY; RUBEOLA, ROM","code_information":[{"code":"3001234","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":114.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":183.0,"discounted_cash":109.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; TETANUS","code_information":[{"code":"3001235","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86774","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":148.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; VARICELLA-ZOSTER","code_information":[{"code":"3001236","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ANTIBODY; WEST NILE VIRUS,","code_information":[{"code":"3001239","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CONCENTRATION, FOR INFECTIOUS AGENTS","code_information":[{"code":"3001241","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE, DEFINITIVE ID, MOLD","code_information":[{"code":"3001242","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":179.0,"discounted_cash":107.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":191.0,"discounted_cash":114.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":438.0,"discounted_cash":262.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":411.0,"discounted_cash":246.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":368.0,"discounted_cash":220.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":310.0,"discounted_cash":186.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":292.0,"discounted_cash":175.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":165.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HISTOPLASMA CAPSULATUM","code_information":[{"code":"3001251","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":459.0,"discounted_cash":275.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":634.0,"discounted_cash":380.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":578.0,"discounted_cash":346.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":645.0,"discounted_cash":387.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE","code_information":[{"code":"3001254","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":234.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":356.0,"discounted_cash":213.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":593.0,"discounted_cash":355.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":574.0,"discounted_cash":344.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":659.0,"discounted_cash":395.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":618.0,"discounted_cash":370.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":679.0,"discounted_cash":407.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":619.0,"discounted_cash":371.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":647.0,"discounted_cash":388.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":592.0,"discounted_cash":355.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC M PNEUMONIA,AMP PROBE","code_information":[{"code":"3001261","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":869.0,"discounted_cash":521.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":794.0,"discounted_cash":476.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC NEISSERIA GONORRHOEAE, LCX","code_information":[{"code":"3001262","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":166.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1327.0,"discounted_cash":796.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1214.0,"discounted_cash":728.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":547.0,"discounted_cash":328.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":529.0,"discounted_cash":317.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1088.0,"discounted_cash":652.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1026.0,"discounted_cash":615.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":769.0,"discounted_cash":461.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":725.0,"discounted_cash":435.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1251.0,"discounted_cash":750.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1179.0,"discounted_cash":707.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":184.0,"discounted_cash":110.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":176.0,"discounted_cash":105.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":2010.0,"discounted_cash":1206.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1647.0,"discounted_cash":988.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":489.0,"discounted_cash":293.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":421.0,"discounted_cash":252.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":3541.0,"discounted_cash":2124.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2702.0,"discounted_cash":1621.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":3801.0,"discounted_cash":2280.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3479.0,"discounted_cash":2087.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CRYOPRESERVATION, EACH CELL LINE","code_information":[{"code":"3001274","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":246.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":376.0,"discounted_cash":225.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CRYOPRESERVATION, EACH CELL LINE","code_information":[{"code":"3001275","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":682.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1040.0,"discounted_cash":624.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":829.0,"discounted_cash":497.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":752.0,"discounted_cash":451.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":479.0,"discounted_cash":287.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2090.0,"discounted_cash":1254.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2028.0,"discounted_cash":1216.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ACETYLCHOLINESTERASE","code_information":[{"code":"3001281","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":383.0,"discounted_cash":229.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO HTLV-1; HTLVI","code_information":[{"code":"3001282","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86687","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":265.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":592.0,"discounted_cash":355.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":540.0,"discounted_cash":324.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DR/DQ, SINGLE ANTIGEN","code_information":[{"code":"3001284","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86816","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":557.0,"discounted_cash":334.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC QUANTITATIVE ASSAY, DRUG","code_information":[{"code":"3001285","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":198.0,"discounted_cash":118.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":181.0,"discounted_cash":108.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IGG SUBCLASSES","code_information":[{"code":"3001289","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":228.0,"discounted_cash":136.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOGLOBULIN BINDING PROTEIN","code_information":[{"code":"3001290","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":304.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":425.0,"discounted_cash":255.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001291","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":212.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":324.0,"discounted_cash":194.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":732.0,"discounted_cash":439.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":689.0,"discounted_cash":413.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001293","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1111.0,"discounted_cash":666.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1016.0,"discounted_cash":609.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OLIGOCLONAL BANDS","code_information":[{"code":"3001322","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.0,"discounted_cash":210.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":320.0,"discounted_cash":192.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":325.0,"discounted_cash":195.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":707.0,"discounted_cash":424.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIPHOSPHATYDLSERINE","code_information":[{"code":"3001325","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.0,"discounted_cash":220.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":336.0,"discounted_cash":201.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":164.0,"discounted_cash":98.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":265.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":166.0,"discounted_cash":99.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; ENCEPH, CALIFORNIA","code_information":[{"code":"3001331","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; ENCEPHALITIS, EASTERN","code_information":[{"code":"3001332","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; ENCEPHALITIS, ST. LOUIS","code_information":[{"code":"3001333","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; ENCEPHALITIS, WESTERN","code_information":[{"code":"3001334","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTIBODY, ENTEROVIRUS; COXA","code_information":[{"code":"3001335","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":123.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FUNGUS,NOT ELSEWHERE SPECIFIED","code_information":[{"code":"3001336","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":168.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; HISTOPLASMA","code_information":[{"code":"3001340","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":113.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":173.0,"discounted_cash":103.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":369.0,"discounted_cash":221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":297.0,"discounted_cash":178.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO ANTIBODY; PARVOVIRUS; PARV","code_information":[{"code":"3001342","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":247.0,"discounted_cash":148.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":232.0,"discounted_cash":139.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; RUBEOLA","code_information":[{"code":"3001345","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":74.0,"discounted_cash":44.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":378.0,"discounted_cash":226.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2061.0,"discounted_cash":1236.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1941.0,"discounted_cash":1164.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CFTR GENE COM VARIANTS","code_information":[{"code":"3001364","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3393.0,"discounted_cash":2035.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3106.0,"discounted_cash":1863.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":2177.0,"discounted_cash":1306.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1992.0,"discounted_cash":1195.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":3646.0,"discounted_cash":2187.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3539.0,"discounted_cash":2123.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":3646.0,"discounted_cash":2187.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3539.0,"discounted_cash":2123.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CYP2D6 GENE COM VARIANTS","code_information":[{"code":"3001370","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81226","type":"HCPCS"}],"standard_charges":[{"gross_charge":3731.0,"discounted_cash":2238.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3415.0,"discounted_cash":2049.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CYTOGEN MICRARRAY COPY NMBR","code_information":[{"code":"3001372","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81228","type":"HCPCS"}],"standard_charges":[{"gross_charge":8351.0,"discounted_cash":5010.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":7640.0,"discounted_cash":4584.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MSH6 GENE KNOWN VARIANTS","code_information":[{"code":"3001373","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":7346.0,"discounted_cash":4407.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6722.0,"discounted_cash":4033.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC EGFR GENE COM VARIANTS","code_information":[{"code":"3001374","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":8651.0,"discounted_cash":5190.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":7915.0,"discounted_cash":4749.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":937.0,"discounted_cash":562.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":908.0,"discounted_cash":544.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":937.0,"discounted_cash":562.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":908.0,"discounted_cash":544.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1675.0,"discounted_cash":1005.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1625.0,"discounted_cash":975.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FMR1 GENE CHARACTERIZATION","code_information":[{"code":"3001379","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81244","type":"HCPCS"}],"standard_charges":[{"gross_charge":834.0,"discounted_cash":500.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":810.0,"discounted_cash":486.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FLT3 GENE","code_information":[{"code":"3001380","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1670.0,"discounted_cash":1002.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1527.0,"discounted_cash":916.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HFE GENE","code_information":[{"code":"3001387","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":1190.0,"discounted_cash":714.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IKBKAP GENE","code_information":[{"code":"3001389","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2799.0,"discounted_cash":1679.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2561.0,"discounted_cash":1536.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":2664.0,"discounted_cash":1598.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2509.0,"discounted_cash":1505.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC STR MARKERS SPECIMEN ANAL","code_information":[{"code":"3001394","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1351.0,"discounted_cash":810.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1237.0,"discounted_cash":742.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO JAK2 GENE; JAK2B","code_information":[{"code":"3001398","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1997.0,"discounted_cash":1198.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1883.0,"discounted_cash":1129.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC KRAS GENE","code_information":[{"code":"3001399","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":994.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1515.0,"discounted_cash":909.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO MTHFR GENE MTHFR","code_information":[{"code":"3001404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":1608.0,"discounted_cash":964.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1515.0,"discounted_cash":909.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1828.0,"discounted_cash":1096.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1773.0,"discounted_cash":1063.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1828.0,"discounted_cash":1096.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1773.0,"discounted_cash":1063.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO NPM1 GENE; NPM1","code_information":[{"code":"3001418","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1738.0,"discounted_cash":1042.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1639.0,"discounted_cash":983.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1237.0,"discounted_cash":742.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1165.0,"discounted_cash":699.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PMP22 GENE DUP/DELET","code_information":[{"code":"3001427","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81324","type":"HCPCS"}],"standard_charges":[{"gross_charge":3340.0,"discounted_cash":2004.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PMP22 GENE FULL SEQUENCE","code_information":[{"code":"3001428","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81325","type":"HCPCS"}],"standard_charges":[{"gross_charge":3340.0,"discounted_cash":2004.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":2555.0,"discounted_cash":1533.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2407.0,"discounted_cash":1444.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1278.0,"discounted_cash":766.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1204.0,"discounted_cash":722.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1278.0,"discounted_cash":766.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1204.0,"discounted_cash":722.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1482.0,"discounted_cash":889.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1397.0,"discounted_cash":838.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":456.0,"discounted_cash":273.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":351.0,"discounted_cash":210.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1787.0,"discounted_cash":1072.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":806.0,"discounted_cash":483.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1826.0,"discounted_cash":1095.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1671.0,"discounted_cash":1002.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":2527.0,"discounted_cash":1516.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2381.0,"discounted_cash":1428.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 4","code_information":[{"code":"3001455","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.0,"discounted_cash":1045.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1592.0,"discounted_cash":955.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 5","code_information":[{"code":"3001456","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81404","type":"HCPCS"}],"standard_charges":[{"gross_charge":3340.0,"discounted_cash":2004.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 6","code_information":[{"code":"3001457","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81405","type":"HCPCS"}],"standard_charges":[{"gross_charge":3340.0,"discounted_cash":2004.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 7","code_information":[{"code":"3001458","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":3340.0,"discounted_cash":2004.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":9708.0,"discounted_cash":5824.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":9150.0,"discounted_cash":5490.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":961.0,"discounted_cash":576.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1120.0,"discounted_cash":672.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DESOXYCORTICOSTERONE, 11","code_information":[{"code":"3001476","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.0,"discounted_cash":343.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":524.0,"discounted_cash":314.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":486.0,"discounted_cash":291.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":156.0,"discounted_cash":93.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1412.0,"discounted_cash":847.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1292.0,"discounted_cash":775.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":187.0,"discounted_cash":112.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY, AMINOLEVULINIC ACID","code_information":[{"code":"3001492","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82135","type":"HCPCS"}],"standard_charges":[{"gross_charge":376.0,"discounted_cash":225.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":345.0,"discounted_cash":207.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIHUMAN GLOBULIN; DIRECT","code_information":[{"code":"3001493","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":491.0,"discounted_cash":294.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":447.0,"discounted_cash":268.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":318.0,"discounted_cash":190.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":190.0,"discounted_cash":114.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":75.0,"discounted_cash":45.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":196.0,"discounted_cash":117.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":179.0,"discounted_cash":107.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":197.0,"discounted_cash":118.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":180.0,"discounted_cash":108.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":456.0,"discounted_cash":273.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":351.0,"discounted_cash":210.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":3340.0,"discounted_cash":2004.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":3340.0,"discounted_cash":2004.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":3058.0,"discounted_cash":1834.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":3492.0,"discounted_cash":2095.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":3195.0,"discounted_cash":1917.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1826.0,"discounted_cash":1095.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":1671.0,"discounted_cash":1002.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":742.0,"discounted_cash":445.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":679.0,"discounted_cash":407.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":742.0,"discounted_cash":445.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":679.0,"discounted_cash":407.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1885.0,"discounted_cash":1131.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1436.0,"discounted_cash":861.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":9708.0,"discounted_cash":5824.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":9150.0,"discounted_cash":5490.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":22.0,"discounted_cash":13.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":16.0,"discounted_cash":9.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":14893.0,"discounted_cash":8935.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":14037.0,"discounted_cash":8422.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":7575.0,"discounted_cash":4545.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":7139.0,"discounted_cash":4283.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1347.0,"discounted_cash":808.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1232.0,"discounted_cash":739.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":358.0,"discounted_cash":214.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":348.0,"discounted_cash":208.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF ARSENIC","code_information":[{"code":"3001533","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO CATECHOLAMINES, PLASMA; CATP","code_information":[{"code":"3001535","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":226.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":354.0,"discounted_cash":212.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CITRATE","code_information":[{"code":"3001536","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":340.0,"discounted_cash":204.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO TELOPEPTIDE URINE NTXPR","code_information":[{"code":"3001537","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ESTRONE","code_information":[{"code":"3001539","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":285.0,"discounted_cash":171.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":261.0,"discounted_cash":156.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC TTG IGA LAB TEST","code_information":[{"code":"3001540","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.0,"discounted_cash":135.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":38.0,"discounted_cash":22.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MAGNESIUM","code_information":[{"code":"3001541","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":276.0,"discounted_cash":165.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF MERCURY","code_information":[{"code":"3001542","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":192.0,"discounted_cash":115.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":395.0,"discounted_cash":237.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":373.0,"discounted_cash":223.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":172.0,"discounted_cash":103.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PHENYLALANINE (PKU) BLOOD","code_information":[{"code":"3001545","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":325.0,"discounted_cash":195.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":265.0,"discounted_cash":159.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":258.0,"discounted_cash":154.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CRYOPRESERVATION, EACH CELL LINE","code_information":[{"code":"3001549","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.0,"discounted_cash":682.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1040.0,"discounted_cash":624.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":213.0,"discounted_cash":127.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":60.0,"discounted_cash":36.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":142.0,"discounted_cash":85.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FLUORESCENT ANTIBODY, TITER","code_information":[{"code":"3001552","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":243.0,"discounted_cash":145.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001555","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3492.0,"discounted_cash":2095.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3195.0,"discounted_cash":1917.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":347.0,"discounted_cash":208.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF PHENYTOIN, TOTAL","code_information":[{"code":"3001557","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC CHLORIDE, FLUID LAB TEST","code_information":[{"code":"3001558","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82438","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":127.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":206.0,"discounted_cash":123.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF URINE POTASSIUM","code_information":[{"code":"3001559","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":100.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF URINE SODIUM","code_information":[{"code":"3001560","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":84.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":129.0,"discounted_cash":77.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":126.0,"discounted_cash":75.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO MICROSOMAL ANTIBODIES; LKM","code_information":[{"code":"3001563","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":378.0,"discounted_cash":226.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":378.0,"discounted_cash":226.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1690.0,"discounted_cash":1014.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1592.0,"discounted_cash":955.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 4","code_information":[{"code":"3001567","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.0,"discounted_cash":1045.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1592.0,"discounted_cash":955.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":102.0,"discounted_cash":61.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1765.0,"discounted_cash":1059.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1663.0,"discounted_cash":997.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":313.0,"discounted_cash":187.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":250.0,"discounted_cash":150.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":97.0,"discounted_cash":58.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":242.0,"discounted_cash":145.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":311.0,"discounted_cash":186.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":293.0,"discounted_cash":175.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":289.0,"discounted_cash":173.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":278.0,"discounted_cash":166.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1697.0,"discounted_cash":1018.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1647.0,"discounted_cash":988.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC HEMOGLOBIN-OXYGEN AFFINITY","code_information":[{"code":"3001591","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82820","type":"HCPCS"}],"standard_charges":[{"gross_charge":509.0,"discounted_cash":305.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":466.0,"discounted_cash":279.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001592","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":110.0,"discounted_cash":66.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":192.0,"discounted_cash":115.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":177.0,"discounted_cash":106.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":119.0,"discounted_cash":71.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":110.0,"discounted_cash":66.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":5369.0,"discounted_cash":3221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4914.0,"discounted_cash":2948.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001596","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":177.0,"discounted_cash":106.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001597","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2888.0,"discounted_cash":1732.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2364.0,"discounted_cash":1418.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FLUORESCENT ANTIBODY, TITER","code_information":[{"code":"3001598","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":702.0,"discounted_cash":421.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; BORRELIA BURGDORFERI","code_information":[{"code":"3001599","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; BORRELIA BURGDORFERI","code_information":[{"code":"3001600","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":174.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":264.0,"discounted_cash":158.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":702.0,"discounted_cash":421.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":213.0,"discounted_cash":127.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":458.0,"discounted_cash":274.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":419.0,"discounted_cash":251.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":253.0,"discounted_cash":151.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":266.0,"discounted_cash":159.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO DRUG SCREENING, BARBITURATES","code_information":[{"code":"3001612","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":1033.0,"discounted_cash":619.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":292.0,"discounted_cash":175.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":646.0,"discounted_cash":387.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":627.0,"discounted_cash":376.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":434.0,"discounted_cash":260.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":420.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":434.0,"discounted_cash":260.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":420.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":142.0,"discounted_cash":85.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":292.0,"discounted_cash":175.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":52.0,"discounted_cash":31.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":240.0,"discounted_cash":144.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":241.0,"discounted_cash":144.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":506.0,"discounted_cash":303.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":477.0,"discounted_cash":286.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":231.0,"discounted_cash":138.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":434.0,"discounted_cash":260.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":420.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":459.0,"discounted_cash":275.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":420.0,"discounted_cash":252.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":292.0,"discounted_cash":175.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG SCREENING, METHADONE","code_information":[{"code":"3001645","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":477.0,"discounted_cash":286.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":479.0,"discounted_cash":287.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":449.0,"discounted_cash":269.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":296.0,"discounted_cash":177.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC VALPROIC ACID, TOTAL","code_information":[{"code":"3001649","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":262.0,"discounted_cash":157.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC VALPROIC ACID, FREE","code_information":[{"code":"3001650","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":262.0,"discounted_cash":157.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":160.0,"discounted_cash":96.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DIGOXIN; TOTAL","code_information":[{"code":"3001652","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":163.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":239.0,"discounted_cash":143.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":232.0,"discounted_cash":139.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":255.0,"discounted_cash":153.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":303.0,"discounted_cash":181.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC VALPROIC ACID, TOTAL","code_information":[{"code":"3001666","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":231.0,"discounted_cash":138.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":254.0,"discounted_cash":152.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG SCREENING, OXYCODONE","code_information":[{"code":"3001669","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":138.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG SCREENING, FENTANYL","code_information":[{"code":"3001670","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":289.0,"discounted_cash":173.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY OF SOMATOSTATIN","code_information":[{"code":"3001674","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1206.0,"discounted_cash":723.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1104.0,"discounted_cash":662.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; BORDETELLA","code_information":[{"code":"3001675","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ANTIBODY; BORDETELLA","code_information":[{"code":"3001676","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC INFECTIOUS AGENT NOS, DIRECT OBS","code_information":[{"code":"3001678","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":91.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":137.0,"discounted_cash":82.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":216.0,"discounted_cash":129.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":843.0,"discounted_cash":505.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":923.0,"discounted_cash":553.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG SCREEN, QUANTITATIVE, ALCOHOLS","code_information":[{"code":"3001683","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.0,"discounted_cash":143.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":218.0,"discounted_cash":130.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":232.0,"discounted_cash":139.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":255.0,"discounted_cash":153.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG SCREENING, COCAINE","code_information":[{"code":"3001685","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":477.0,"discounted_cash":286.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":192.0,"discounted_cash":115.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":185.0,"discounted_cash":111.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MOPATH PROCEDURE LEVEL 2","code_information":[{"code":"3001688","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":1418.0,"discounted_cash":850.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1248.0,"discounted_cash":748.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":516.0,"discounted_cash":309.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":472.0,"discounted_cash":283.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":342.0,"discounted_cash":205.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001691","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  IMMUNOASSAY, ANALYTE, QUANT, NOS","code_information":[{"code":"3001692","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":5205.0,"discounted_cash":3123.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4761.0,"discounted_cash":2856.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":216.0,"discounted_cash":129.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":197.0,"discounted_cash":118.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":294.0,"discounted_cash":176.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG SCREEN QUANT ALCOHOLS","code_information":[{"code":"3001696","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":291.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":471.0,"discounted_cash":282.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":587.0,"discounted_cash":352.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":569.0,"discounted_cash":341.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2418.0,"discounted_cash":1450.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2325.0,"discounted_cash":1395.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":155.0,"discounted_cash":93.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":148.0,"discounted_cash":88.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO THYROGLOBULIN ANTIBODY, HTG2","code_information":[{"code":"3001703","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":50.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":81.0,"discounted_cash":48.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":96.0,"discounted_cash":57.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":93.0,"discounted_cash":55.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":357.0,"discounted_cash":214.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY","code_information":[{"code":"3001706","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.0,"discounted_cash":95.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":153.0,"discounted_cash":91.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1221.0,"discounted_cash":732.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1185.0,"discounted_cash":711.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":464.0,"discounted_cash":278.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":448.0,"discounted_cash":268.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":479.0,"discounted_cash":287.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":188.0,"discounted_cash":112.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":41.0,"discounted_cash":24.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":39.0,"discounted_cash":23.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ALKALOIDS, NOT OTHERWISE SPECIFIED","code_information":[{"code":"3001712","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":217.0,"discounted_cash":130.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":429.0,"discounted_cash":257.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":417.0,"discounted_cash":250.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":429.0,"discounted_cash":257.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":417.0,"discounted_cash":250.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":300.0,"discounted_cash":180.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":291.0,"discounted_cash":174.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":232.0,"discounted_cash":139.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":204.0,"discounted_cash":122.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":196.0,"discounted_cash":117.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED MOLECULAR PATHOLOGY PROCEDURE","code_information":[{"code":"3001742","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2205.0,"discounted_cash":1323.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2141.0,"discounted_cash":1284.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":513.0,"discounted_cash":307.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":496.0,"discounted_cash":297.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":531.0,"discounted_cash":318.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":131.0,"discounted_cash":78.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":128.0,"discounted_cash":76.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":294.0,"discounted_cash":176.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":287.0,"discounted_cash":172.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1366.0,"discounted_cash":819.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1326.0,"discounted_cash":795.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1366.0,"discounted_cash":819.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1326.0,"discounted_cash":795.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PED PROF CORTISOL TOTAL","code_information":[{"code":"3001750","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":117.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":189.0,"discounted_cash":113.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PED PROF DESOXYCORTICOSTERONE 11","code_information":[{"code":"3001751","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":223.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":358.0,"discounted_cash":214.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":250.0,"discounted_cash":150.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":242.0,"discounted_cash":145.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":280.0,"discounted_cash":168.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":280.0,"discounted_cash":168.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1916.0,"discounted_cash":1149.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1861.0,"discounted_cash":1116.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":36.0,"discounted_cash":21.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":35.0,"discounted_cash":21.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":49.0,"discounted_cash":29.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":47.0,"discounted_cash":28.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":66.0,"discounted_cash":39.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":110.0,"discounted_cash":66.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":105.0,"discounted_cash":63.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":116.0,"discounted_cash":69.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":96.0,"discounted_cash":57.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":93.0,"discounted_cash":55.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":96.0,"discounted_cash":57.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":93.0,"discounted_cash":55.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":125.0,"discounted_cash":75.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":169.0,"discounted_cash":101.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":5210.0,"discounted_cash":3126.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":5058.0,"discounted_cash":3034.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6219.0,"discounted_cash":3731.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6037.0,"discounted_cash":3622.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":3684.0,"discounted_cash":2210.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3577.0,"discounted_cash":2146.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":651.0,"discounted_cash":390.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":633.0,"discounted_cash":379.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC KRAS MUTATION COLORECTRAL, KRASC","code_information":[{"code":"3001768","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1508.0,"discounted_cash":904.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1464.0,"discounted_cash":878.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO SLIDE REVIEW, SLIRV","code_information":[{"code":"3001769","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":142.0,"discounted_cash":85.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO INSULIN TOTAL, INSFT","code_information":[{"code":"3001771","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":55.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO INSULIN FREE, INSFT","code_information":[{"code":"3001772","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":62.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":99.0,"discounted_cash":59.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":324.0,"discounted_cash":194.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":312.0,"discounted_cash":187.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3584.0,"discounted_cash":2150.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1679.0,"discounted_cash":1007.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1394.0,"discounted_cash":836.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2046.0,"discounted_cash":1227.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1987.0,"discounted_cash":1192.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":142.0,"discounted_cash":85.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1380.0,"discounted_cash":828.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1339.0,"discounted_cash":803.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC COMP ANALYSIS STR, STR1","code_information":[{"code":"3001781","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1658.0,"discounted_cash":994.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1609.0,"discounted_cash":965.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC COMP ANALYSIS STR, STR2","code_information":[{"code":"3001782","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81266","type":"HCPCS"}],"standard_charges":[{"gross_charge":738.0,"discounted_cash":442.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":716.0,"discounted_cash":429.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO HISTOPLASMA AB, SHSTO","code_information":[{"code":"3001783","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.0,"discounted_cash":129.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":208.0,"discounted_cash":124.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SOADENOVIRUS PCR, LCADP","code_information":[{"code":"3001784","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":227.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":368.0,"discounted_cash":220.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO  LEGIONELLA PCR, LEGRP","code_information":[{"code":"3001785","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.0,"discounted_cash":250.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":404.0,"discounted_cash":242.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":397.0,"discounted_cash":238.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":386.0,"discounted_cash":231.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":397.0,"discounted_cash":238.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":386.0,"discounted_cash":231.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":166.0,"discounted_cash":99.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":142.0,"discounted_cash":85.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":135.0,"discounted_cash":81.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":429.0,"discounted_cash":257.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":417.0,"discounted_cash":250.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":456.0,"discounted_cash":273.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":75.0,"discounted_cash":45.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":75.0,"discounted_cash":45.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1161.0,"discounted_cash":696.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1128.0,"discounted_cash":676.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1497.0,"discounted_cash":898.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1454.0,"discounted_cash":872.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":112.0,"discounted_cash":67.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":715.0,"discounted_cash":429.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":694.0,"discounted_cash":416.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO RUFINAMIDE SERUM RUFI","code_information":[{"code":"3001810","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.0,"discounted_cash":139.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":340.0,"discounted_cash":204.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":330.0,"discounted_cash":198.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY HAPTOGLOBIN QUANT FHIB","code_information":[{"code":"3001812","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.0,"discounted_cash":187.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":305.0,"discounted_cash":183.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY APOLIPROTEIN EA FHIB","code_information":[{"code":"3001813","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":338.0,"discounted_cash":202.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ASSAY GLUTAMYLTRASE GAMMA FHIB","code_information":[{"code":"3001814","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":53.0,"discounted_cash":31.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BILIRUBIN TOTAL FHIB","code_information":[{"code":"3001815","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":53.0,"discounted_cash":31.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":56.0,"discounted_cash":33.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":53.0,"discounted_cash":31.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":479.0,"discounted_cash":287.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":501.0,"discounted_cash":300.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":501.0,"discounted_cash":300.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":522.0,"discounted_cash":313.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":351.0,"discounted_cash":210.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO BILIRUBIN TOTAL FLFFT","code_information":[{"code":"3001823","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":35.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":56.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":59.0,"discounted_cash":35.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":56.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":353.0,"discounted_cash":211.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":343.0,"discounted_cash":205.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":59.0,"discounted_cash":35.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":56.0,"discounted_cash":33.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":458.0,"discounted_cash":274.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":443.0,"discounted_cash":265.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE; SCREENING ONLY LAB4550","code_information":[{"code":"3001829","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":310.0,"discounted_cash":186.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":301.0,"discounted_cash":180.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":115.0,"discounted_cash":69.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":648.0,"discounted_cash":388.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":629.0,"discounted_cash":377.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":587.0,"discounted_cash":352.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":569.0,"discounted_cash":341.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":400.0,"discounted_cash":240.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":388.0,"discounted_cash":232.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":321.0,"discounted_cash":192.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":147.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":147.0,"discounted_cash":88.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":156.0,"discounted_cash":93.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1513.0,"discounted_cash":907.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1213.0,"discounted_cash":727.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1178.0,"discounted_cash":706.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1099.0,"discounted_cash":659.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1068.0,"discounted_cash":640.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":94.0,"discounted_cash":56.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":110.0,"discounted_cash":66.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":56.0,"discounted_cash":33.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":53.0,"discounted_cash":31.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":66.0,"discounted_cash":39.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":62.0,"discounted_cash":37.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO LACTATE DEHYDROGENAS LDH","code_information":[{"code":"3001849","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":49.0,"discounted_cash":29.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":100.0,"discounted_cash":60.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":208.0,"discounted_cash":124.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":202.0,"discounted_cash":121.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":85.0,"discounted_cash":51.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":76.0,"discounted_cash":45.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":504.0,"discounted_cash":302.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":489.0,"discounted_cash":293.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO FUNGITELL SERUM FUNGS","code_information":[{"code":"3001855","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":332.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":535.0,"discounted_cash":321.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":145.0,"discounted_cash":87.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":140.0,"discounted_cash":84.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":145.0,"discounted_cash":87.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":326.0,"discounted_cash":195.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":191.0,"discounted_cash":114.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":184.0,"discounted_cash":110.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":191.0,"discounted_cash":114.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":183.0,"discounted_cash":109.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":178.0,"discounted_cash":106.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":96.0,"discounted_cash":57.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":93.0,"discounted_cash":55.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":96.0,"discounted_cash":57.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":93.0,"discounted_cash":55.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":93.0,"discounted_cash":55.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":84.0,"discounted_cash":50.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":81.0,"discounted_cash":48.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":84.0,"discounted_cash":50.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":81.0,"discounted_cash":48.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":351.0,"discounted_cash":210.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":340.0,"discounted_cash":204.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":351.0,"discounted_cash":210.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":340.0,"discounted_cash":204.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":338.0,"discounted_cash":202.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":328.0,"discounted_cash":196.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":515.0,"discounted_cash":309.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":499.0,"discounted_cash":299.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":468.0,"discounted_cash":280.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":455.0,"discounted_cash":273.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":52.0,"discounted_cash":31.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":50.0,"discounted_cash":30.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":53.0,"discounted_cash":31.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":51.0,"discounted_cash":30.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":53.0,"discounted_cash":31.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":51.0,"discounted_cash":30.6,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":171.0,"discounted_cash":102.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":84.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":84.0,"discounted_cash":50.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":80.0,"discounted_cash":48.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":32.0,"discounted_cash":19.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":31.0,"discounted_cash":18.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":27.0,"discounted_cash":16.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":33.0,"discounted_cash":19.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":35.0,"discounted_cash":21.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":34.0,"discounted_cash":20.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":32.0,"discounted_cash":19.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":156.0,"discounted_cash":93.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":23.0,"discounted_cash":13.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":22.0,"discounted_cash":13.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":32.0,"discounted_cash":19.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":73.0,"discounted_cash":43.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":43.0,"discounted_cash":25.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":41.0,"discounted_cash":24.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":39.0,"discounted_cash":23.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":38.0,"discounted_cash":22.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":44.0,"discounted_cash":26.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":43.0,"discounted_cash":25.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":94.0,"discounted_cash":56.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":91.0,"discounted_cash":54.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":32.0,"discounted_cash":19.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":115.0,"discounted_cash":69.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":115.0,"discounted_cash":69.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":147.0,"discounted_cash":88.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":85.0,"discounted_cash":51.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":82.0,"discounted_cash":49.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1093.0,"discounted_cash":655.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1063.0,"discounted_cash":637.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":444.0,"discounted_cash":266.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":419.0,"discounted_cash":251.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1237.0,"discounted_cash":742.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1200.0,"discounted_cash":720.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":347.0,"discounted_cash":208.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":337.0,"discounted_cash":202.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":405.0,"discounted_cash":243.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":447.0,"discounted_cash":268.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":435.0,"discounted_cash":261.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":300.0,"discounted_cash":180.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":549.0,"discounted_cash":329.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":530.0,"discounted_cash":318.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":305.0,"discounted_cash":183.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":296.0,"discounted_cash":177.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1074.0,"discounted_cash":644.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":913.0,"discounted_cash":547.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":913.0,"discounted_cash":547.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":540.0,"discounted_cash":324.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":524.0,"discounted_cash":314.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":221.0,"discounted_cash":132.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":244.0,"discounted_cash":146.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":237.0,"discounted_cash":142.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1395.0,"discounted_cash":837.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1356.0,"discounted_cash":813.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":2205.0,"discounted_cash":1323.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2141.0,"discounted_cash":1284.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":685.0,"discounted_cash":411.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":592.0,"discounted_cash":355.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ALKALOIDS NOS, NICOU","code_information":[{"code":"3001932","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":87.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":489.0,"discounted_cash":293.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":72.0,"discounted_cash":43.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":108.0,"discounted_cash":64.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":629.0,"discounted_cash":377.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":93.0,"discounted_cash":55.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":93.0,"discounted_cash":55.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":354.0,"discounted_cash":212.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":354.0,"discounted_cash":212.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":339.0,"discounted_cash":203.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":519.0,"discounted_cash":311.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":472.0,"discounted_cash":283.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":184.0,"discounted_cash":110.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":184.0,"discounted_cash":110.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC PLATELET INHIBITION ASSAY","code_information":[{"code":"3001953","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":594.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":44.0,"discounted_cash":26.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":76.0,"discounted_cash":45.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":49.0,"discounted_cash":29.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":60.0,"discounted_cash":36.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":52.0,"discounted_cash":31.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":52.0,"discounted_cash":31.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MACROPROLACTIN TOTPROL/MCRPL","code_information":[{"code":"3001962","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MACROPROLACTIN UNPRECIP/MCRPL","code_information":[{"code":"3001963","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":85.0,"discounted_cash":51.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HISTONE AUTOANTIBODIES HIS","code_information":[{"code":"3001965","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HBRP BLASTOAG/FBLAS","code_information":[{"code":"3001966","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":489.0,"discounted_cash":293.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO FUNGITELL FUNGS","code_information":[{"code":"3001967","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TILAPIA IGE FFTIL","code_information":[{"code":"3001969","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":124.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":291.0,"discounted_cash":174.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":281.0,"discounted_cash":168.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO IMMUNOGLOBULIN D IGD","code_information":[{"code":"3001976","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":44.0,"discounted_cash":26.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":44.0,"discounted_cash":26.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":23.0,"discounted_cash":13.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":23.0,"discounted_cash":13.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":58.0,"discounted_cash":34.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":58.0,"discounted_cash":34.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":32.0,"discounted_cash":19.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":124.0,"discounted_cash":74.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":124.0,"discounted_cash":74.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":32.0,"discounted_cash":19.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":32.0,"discounted_cash":19.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":35.0,"discounted_cash":21.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":52.0,"discounted_cash":31.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":52.0,"discounted_cash":31.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":60.0,"discounted_cash":36.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":191.0,"discounted_cash":114.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":191.0,"discounted_cash":114.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":15.0,"discounted_cash":9.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":62.0,"discounted_cash":37.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":53.0,"discounted_cash":31.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO AMIODARONE SERUM AMIO","code_information":[{"code":"3002009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":74.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":84.0,"discounted_cash":50.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":119.0,"discounted_cash":71.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO SULFTIDE AUTOANTIBODY FSUAB","code_information":[{"code":"3002019","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.0,"discounted_cash":687.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1146.0,"discounted_cash":687.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":124.0,"discounted_cash":74.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":124.0,"discounted_cash":74.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":369.0,"discounted_cash":221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":369.0,"discounted_cash":221.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":496.0,"discounted_cash":297.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":888.0,"discounted_cash":532.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":888.0,"discounted_cash":532.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1574.0,"discounted_cash":944.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":390.0,"discounted_cash":234.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":79.0,"discounted_cash":47.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":92.0,"discounted_cash":55.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":92.0,"discounted_cash":55.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1206.0,"discounted_cash":723.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1098.0,"discounted_cash":658.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":540.0,"discounted_cash":324.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":578.0,"discounted_cash":346.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":272.0,"discounted_cash":163.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":272.0,"discounted_cash":163.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":85.0,"discounted_cash":51.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":115.0,"discounted_cash":69.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":117.0,"discounted_cash":70.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":698.0,"discounted_cash":418.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":698.0,"discounted_cash":418.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":108.0,"discounted_cash":64.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":129.0,"discounted_cash":77.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":107.0,"discounted_cash":64.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CALPROTECTIN, FECAL CALPR","code_information":[{"code":"3002058","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.0,"discounted_cash":445.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO OXYCODONE FOPIA","code_information":[{"code":"3002060","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":108.0,"discounted_cash":64.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":129.0,"discounted_cash":77.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":129.0,"discounted_cash":77.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":129.0,"discounted_cash":77.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":129.0,"discounted_cash":77.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":71.0,"discounted_cash":42.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":393.0,"discounted_cash":235.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":296.0,"discounted_cash":177.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TYSABRI IMMUNOGENICITY FSABI","code_information":[{"code":"3002078","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":1410.0,"discounted_cash":846.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":376.0,"discounted_cash":225.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":442.0,"discounted_cash":265.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":442.0,"discounted_cash":265.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":456.0,"discounted_cash":273.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":456.0,"discounted_cash":273.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":323.0,"discounted_cash":193.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":257.0,"discounted_cash":154.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO NMO AQP4 NMOFS","code_information":[{"code":"3002144","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":402.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":85.0,"discounted_cash":51.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":637.0,"discounted_cash":382.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":579.0,"discounted_cash":347.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":45.0,"discounted_cash":27.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":365.0,"discounted_cash":219.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO EVEROLIMUS, EVROL","code_information":[{"code":"3002156","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":528.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC REFLEX, HIV 1 CONF","code_information":[{"code":"3002158","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC REFLEX, HIV 2 CONF","code_information":[{"code":"3002159","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":198.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PROGESTERONE PGSN","code_information":[{"code":"3002160","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.0,"discounted_cash":315.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":707.0,"discounted_cash":424.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":707.0,"discounted_cash":424.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":92.0,"discounted_cash":55.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":208.0,"discounted_cash":124.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":208.0,"discounted_cash":124.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":208.0,"discounted_cash":124.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SFMC GBM LAB TEST","code_information":[{"code":"3002170","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO LIPOPROTEIN PLA2 PLACA","code_information":[{"code":"3002172","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":37.0,"discounted_cash":22.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TRIGLYCERIDES; FNMR2","code_information":[{"code":"3002175","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":19.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":48.0,"discounted_cash":28.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":48.0,"discounted_cash":28.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":45.0,"discounted_cash":27.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":45.0,"discounted_cash":27.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CYSTATIN CYSTC","code_information":[{"code":"3002182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":102.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SFMC PR3 LAB TEST","code_information":[{"code":"3002184","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":287.0,"discounted_cash":172.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":152.0,"discounted_cash":91.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":707.0,"discounted_cash":424.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":707.0,"discounted_cash":424.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":211.0,"discounted_cash":126.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":340.0,"discounted_cash":204.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":277.0,"discounted_cash":166.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1183.0,"discounted_cash":709.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1084.0,"discounted_cash":650.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG TEST, PRESUMPTIVE,URINE DRUG SCREENING","code_information":[{"code":"3002201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":240.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":557.0,"discounted_cash":334.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1183.0,"discounted_cash":709.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1084.0,"discounted_cash":650.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":846.0,"discounted_cash":507.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":774.0,"discounted_cash":464.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1183.0,"discounted_cash":709.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1084.0,"discounted_cash":650.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":846.0,"discounted_cash":507.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":774.0,"discounted_cash":464.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":113.0,"discounted_cash":67.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":297.0,"discounted_cash":178.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":247.0,"discounted_cash":148.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":98.0,"discounted_cash":58.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":98.0,"discounted_cash":58.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":342.0,"discounted_cash":205.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":332.0,"discounted_cash":199.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":342.0,"discounted_cash":205.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":332.0,"discounted_cash":199.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC GLIADIN IGA LAB TEST","code_information":[{"code":"3002223","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":36.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":38.0,"discounted_cash":22.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":317.0,"discounted_cash":190.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":308.0,"discounted_cash":184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":298.0,"discounted_cash":178.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC IGA LAB TEST","code_information":[{"code":"3002228","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC IGG LAB TEST","code_information":[{"code":"3002229","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":213.0,"discounted_cash":127.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1721.0,"discounted_cash":1032.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1161.0,"discounted_cash":696.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":499.0,"discounted_cash":299.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":162.0,"discounted_cash":97.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TESTOSTERONE BIOAVAIL TTFB","code_information":[{"code":"3002239","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":71.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":119.0,"discounted_cash":71.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SO TESTOSTERONE TOTAL TTFB","code_information":[{"code":"3002240","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":54.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TESTOSTERONE FREE TTFB","code_information":[{"code":"3002241","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":53.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":931.0,"discounted_cash":558.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":395.0,"discounted_cash":237.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1008.0,"discounted_cash":604.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":630.0,"discounted_cash":378.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC LACTAL LAB TEST","code_information":[{"code":"3002251","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SFMC BLACTO LAB TEST","code_information":[{"code":"3002252","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":211.0,"discounted_cash":126.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":253.0,"discounted_cash":151.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1304.0,"discounted_cash":782.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1119.0,"discounted_cash":671.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1304.0,"discounted_cash":782.4,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":1119.0,"discounted_cash":671.4,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":492.0,"discounted_cash":295.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":766.0,"discounted_cash":459.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":604.0,"discounted_cash":362.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":823.0,"discounted_cash":493.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":274.0,"discounted_cash":164.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO LEPTOSPIRA IGM LEPDT","code_information":[{"code":"3002266","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":457.0,"discounted_cash":274.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1297.0,"discounted_cash":778.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO INHIBIN B, INHB","code_information":[{"code":"3002269","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":478.0,"discounted_cash":286.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":478.0,"discounted_cash":286.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":204.0,"discounted_cash":122.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":234.0,"discounted_cash":140.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ALBUMIN FTTST LAB TEST","code_information":[{"code":"3002272","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":84.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":133.0,"discounted_cash":79.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":552.0,"discounted_cash":331.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":533.0,"discounted_cash":319.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":208.0,"discounted_cash":124.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":208.0,"discounted_cash":124.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":348.0,"discounted_cash":208.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":348.0,"discounted_cash":208.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":208.0,"discounted_cash":124.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":348.0,"discounted_cash":208.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":177.0,"discounted_cash":106.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":177.0,"discounted_cash":106.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":348.0,"discounted_cash":208.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":348.0,"discounted_cash":208.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":98.0,"discounted_cash":58.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MISC VOLATILES","code_information":[{"code":"3002367","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":592.0,"discounted_cash":355.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":506.0,"discounted_cash":303.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":125.0,"discounted_cash":75.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CARNITINE URINE CARN","code_information":[{"code":"3002392","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DESOXYCORTICOSTERONE, FFCAH","code_information":[{"code":"3002394","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82633","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DEOXYCORTISOL, FFCAH","code_information":[{"code":"3002395","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82634","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.0,"discounted_cash":203.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":339.0,"discounted_cash":203.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TOTAL CORTISOL, FFCAH","code_information":[{"code":"3002397","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.0,"discounted_cash":113.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DEHYDROEPIANDROSTERONE, FFCAH","code_information":[{"code":"3002398","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":175.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":264.0,"discounted_cash":158.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":242.0,"discounted_cash":145.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":313.0,"discounted_cash":187.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TESTOSTERONE TOTAL, FFCAH","code_information":[{"code":"3002402","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":168.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":671.0,"discounted_cash":402.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX MUCOPOLYSACCHARIDOSIS, MPSBS","code_information":[{"code":"3002404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":522.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX PSYCHOSINE, PSY","code_information":[{"code":"3002405","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":336.0,"discounted_cash":201.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":336.0,"discounted_cash":201.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":211.0,"discounted_cash":126.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":211.0,"discounted_cash":126.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":211.0,"discounted_cash":126.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":211.0,"discounted_cash":126.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":211.0,"discounted_cash":126.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":309.0,"discounted_cash":185.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":188.0,"discounted_cash":112.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":827.0,"discounted_cash":496.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":769.0,"discounted_cash":461.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":164.0,"discounted_cash":98.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1119.0,"discounted_cash":671.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":407.0,"discounted_cash":244.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX ANN1S","code_information":[{"code":"3002435","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX ANN2S","code_information":[{"code":"3002436","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX ANN3S","code_information":[{"code":"3002437","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX PCABP","code_information":[{"code":"3002438","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX PCAB2","code_information":[{"code":"3002439","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX PCATR","code_information":[{"code":"3002440","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX AMPHS","code_information":[{"code":"3002441","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1163.0,"discounted_cash":697.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1163.0,"discounted_cash":697.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1320.0,"discounted_cash":792.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX CS2CS-CASPR2","code_information":[{"code":"3002446","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MANGANESE-B MNB","code_information":[{"code":"3002447","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":537.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MANGANESE-SERUM MNS","code_information":[{"code":"3002448","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":852.0,"discounted_cash":511.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":604.0,"discounted_cash":362.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MISC HEP C AB TEST","code_information":[{"code":"3002465","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":280.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":168.0,"discounted_cash":100.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":168.0,"discounted_cash":100.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":635.0,"discounted_cash":381.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1158.0,"discounted_cash":694.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ADALIMUMAB AB ADLAB","code_information":[{"code":"3002520","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.0,"discounted_cash":448.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":671.0,"discounted_cash":402.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":214.0,"discounted_cash":128.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1163.0,"discounted_cash":697.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX AMPCC","code_information":[{"code":"3002528","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.0,"discounted_cash":1207.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX LG1CC","code_information":[{"code":"3002529","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":350.0,"discounted_cash":210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX CS2CC","code_information":[{"code":"3002531","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX NMDCC","code_information":[{"code":"3002532","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.0,"discounted_cash":1207.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX GABCC","code_information":[{"code":"3002533","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.0,"discounted_cash":1207.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX VGKCC","code_information":[{"code":"3002534","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.0,"discounted_cash":792.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CORTISOL, FREE; CORTF","code_information":[{"code":"3002536","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":337.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1342.0,"discounted_cash":805.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX WBNC","code_information":[{"code":"3002539","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":697.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX GABIC","code_information":[{"code":"3002540","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX CRMWC","code_information":[{"code":"3002541","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":697.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX NMDIC","code_information":[{"code":"3002542","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1163.0,"discounted_cash":697.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":827.0,"discounted_cash":496.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX NMOFC","code_information":[{"code":"3002545","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1320.0,"discounted_cash":792.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX NMOTC","code_information":[{"code":"3002546","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO SYPHILIS AB, TPPA","code_information":[{"code":"3002547","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":302.0,"discounted_cash":181.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":291.0,"discounted_cash":174.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":302.0,"discounted_cash":181.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1320.0,"discounted_cash":792.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":782.0,"discounted_cash":469.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO INFLIXIMAB AB, INXAB","code_information":[{"code":"3002554","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO VORICONAZOLE, VORI","code_information":[{"code":"3002555","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":168.0,"discounted_cash":100.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":124.0,"discounted_cash":74.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":464.0,"discounted_cash":278.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1106.0,"discounted_cash":663.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":369.0,"discounted_cash":221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY; PARVOVIRUS, PARVS","code_information":[{"code":"3002593","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":46.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":77.0,"discounted_cash":46.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":984.0,"discounted_cash":590.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":671.0,"discounted_cash":402.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":296.0,"discounted_cash":177.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":541.0,"discounted_cash":324.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":506.0,"discounted_cash":303.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":852.0,"discounted_cash":511.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":604.0,"discounted_cash":362.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":108.0,"discounted_cash":64.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":581.0,"discounted_cash":348.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":351.0,"discounted_cash":210.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":447.0,"discounted_cash":268.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":145.0,"discounted_cash":87.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":264.0,"discounted_cash":158.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":114.0,"discounted_cash":68.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":376.0,"discounted_cash":225.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":207.0,"discounted_cash":124.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":263.0,"discounted_cash":157.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":708.0,"discounted_cash":424.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":708.0,"discounted_cash":424.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":387.0,"discounted_cash":232.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":387.0,"discounted_cash":232.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":708.0,"discounted_cash":424.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1039.0,"discounted_cash":623.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":974.0,"discounted_cash":584.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHLAMYDIA CULTURE, FCLCU","code_information":[{"code":"3002682","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":104.0,"discounted_cash":62.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":80.0,"discounted_cash":48.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":682.0,"discounted_cash":409.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":357.0,"discounted_cash":214.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":55.0,"discounted_cash":33.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":80.0,"discounted_cash":48.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":627.0,"discounted_cash":376.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TRICHOMONAS VAGINALIS, MTRNA","code_information":[{"code":"3002693","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":682.0,"discounted_cash":409.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":481.0,"discounted_cash":288.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":593.0,"discounted_cash":355.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":76.0,"discounted_cash":45.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":76.0,"discounted_cash":45.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2064.0,"discounted_cash":1238.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2064.0,"discounted_cash":1238.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CYCLOSPORINE, PEAK, CYCPK","code_information":[{"code":"3002705","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":52.0,"discounted_cash":31.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC REF FERN","code_information":[{"code":"3002707","type":"CDM"},{"code":"0300","type":"RC"},{"code":"Q0114","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":31.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":93.0,"discounted_cash":55.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":93.0,"discounted_cash":55.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":88.0,"discounted_cash":52.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":224.0,"discounted_cash":134.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":390.0,"discounted_cash":234.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":381.0,"discounted_cash":228.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":871.0,"discounted_cash":522.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ENC1 ANNA2","code_information":[{"code":"3002726","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":120.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ENC1 ANNA1","code_information":[{"code":"3002727","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ENC1 AGNA-1","code_information":[{"code":"3002735","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ENC1 LGI1","code_information":[{"code":"3002740","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":201.0,"discounted_cash":120.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":60.0,"discounted_cash":36.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":60.0,"discounted_cash":36.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":60.0,"discounted_cash":36.0,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ENTEROVIRUS, ENTP","code_information":[{"code":"3002746","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":419.0,"discounted_cash":251.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO APOLIPOPROTEIN FIBRO APO","code_information":[{"code":"3002764","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HAPTOGLOBIN FIBRO HAP","code_information":[{"code":"3002766","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":652.0,"discounted_cash":391.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":423.0,"discounted_cash":253.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":509.0,"discounted_cash":305.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":112.0,"discounted_cash":67.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1418.0,"discounted_cash":850.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":615.0,"discounted_cash":369.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":615.0,"discounted_cash":369.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":570.0,"discounted_cash":342.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":162.0,"discounted_cash":97.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":402.0,"discounted_cash":241.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":449.0,"discounted_cash":269.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO THROMBIN TIME, THRMP","code_information":[{"code":"3002786","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO THROMBIN APTT, THRMP","code_information":[{"code":"3002787","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":37.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PROTHROMBIN PT, THRMP","code_information":[{"code":"3002788","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":21.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO D-DIMER, THRMP","code_information":[{"code":"3002789","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":66.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":102.0,"discounted_cash":61.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO FIBRINOGEN, THRMP","code_information":[{"code":"3002794","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":55.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO FIBRIN MONOMER, THRMP","code_information":[{"code":"3002795","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85366","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.0,"discounted_cash":417.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":368.0,"discounted_cash":220.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":357.0,"discounted_cash":214.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":648.0,"discounted_cash":388.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":895.0,"discounted_cash":537.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":535.0,"discounted_cash":321.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":381.0,"discounted_cash":228.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CADMIUM, CDUO","code_information":[{"code":"3002815","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":703.0,"discounted_cash":421.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CADMIUM, HMU24","code_information":[{"code":"3002816","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":551.0,"discounted_cash":330.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ARSENIC, HMU24","code_information":[{"code":"3002817","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":270.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MERCURY, QUANTITATIVE, HMU24","code_information":[{"code":"3002818","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":387.0,"discounted_cash":232.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO LEAD, HMU24","code_information":[{"code":"3002819","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":173.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1787.0,"discounted_cash":1072.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1787.0,"discounted_cash":1072.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2347.0,"discounted_cash":1408.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1418.0,"discounted_cash":850.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC REF LEVETIRACETAM, LEVET","code_information":[{"code":"3002828","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":154.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":216.0,"discounted_cash":129.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":216.0,"discounted_cash":129.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":216.0,"discounted_cash":129.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":216.0,"discounted_cash":129.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":216.0,"discounted_cash":129.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":288.0,"discounted_cash":172.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":226.0,"discounted_cash":135.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":226.0,"discounted_cash":135.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":226.0,"discounted_cash":135.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":226.0,"discounted_cash":135.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":226.0,"discounted_cash":135.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":300.0,"discounted_cash":180.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":182.0,"discounted_cash":109.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":535.0,"discounted_cash":321.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":305.0,"discounted_cash":183.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":305.0,"discounted_cash":183.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":288.0,"discounted_cash":172.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":792.0,"discounted_cash":475.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":581.0,"discounted_cash":348.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":613.0,"discounted_cash":367.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":573.0,"discounted_cash":343.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1082.0,"discounted_cash":649.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":870.0,"discounted_cash":522.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":279.0,"discounted_cash":167.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":134.0,"discounted_cash":80.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":183.0,"discounted_cash":109.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":447.0,"discounted_cash":268.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1067.0,"discounted_cash":640.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":479.0,"discounted_cash":287.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":823.0,"discounted_cash":493.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":868.0,"discounted_cash":520.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":290.0,"discounted_cash":174.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":823.0,"discounted_cash":493.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":207.0,"discounted_cash":124.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":352.0,"discounted_cash":211.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":380.0,"discounted_cash":228.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":465.0,"discounted_cash":279.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":635.0,"discounted_cash":381.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":380.0,"discounted_cash":228.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":465.0,"discounted_cash":279.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":635.0,"discounted_cash":381.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1787.0,"discounted_cash":1072.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":365.0,"discounted_cash":219.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO COPEPTIN PROAVP, CPAVP","code_information":[{"code":"3002949","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.0,"discounted_cash":268.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":806.0,"discounted_cash":483.6,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PENTOBARBITAL, PENTS","code_information":[{"code":"3002967","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":189.0,"discounted_cash":113.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":189.0,"discounted_cash":113.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":334.0,"discounted_cash":200.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":315.0,"discounted_cash":189.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":228.0,"discounted_cash":136.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":228.0,"discounted_cash":136.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":293.0,"discounted_cash":175.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":167.0,"discounted_cash":100.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":167.0,"discounted_cash":100.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":483.0,"discounted_cash":289.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1027.0,"discounted_cash":616.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":516.0,"discounted_cash":309.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1157.0,"discounted_cash":694.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":652.0,"discounted_cash":391.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1098.0,"discounted_cash":658.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1157.0,"discounted_cash":694.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":317.0,"discounted_cash":190.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":348.0,"discounted_cash":208.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1541.0,"discounted_cash":924.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":516.0,"discounted_cash":309.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":98.0,"discounted_cash":58.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":132.0,"discounted_cash":79.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":258.0,"discounted_cash":154.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":258.0,"discounted_cash":154.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO QUANT POSACONAZOLE, POSA","code_information":[{"code":"3003014","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":976.0,"discounted_cash":585.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":447.0,"discounted_cash":268.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":716.0,"discounted_cash":429.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CALCULUS SPECTROSCOPY KIDST","code_information":[{"code":"3003073","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":586.0,"discounted_cash":351.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SFMC ASSAY OF TOPIRAMATE","code_information":[{"code":"3003077","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":226.0,"discounted_cash":135.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":237.0,"discounted_cash":142.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":227.0,"discounted_cash":136.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":215.0,"discounted_cash":129.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":868.0,"discounted_cash":520.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":309.0,"discounted_cash":185.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":160.0,"discounted_cash":96.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":258.0,"discounted_cash":154.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":258.0,"discounted_cash":154.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":856.0,"discounted_cash":513.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":64.0,"discounted_cash":38.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO APTT ,APTSC, AATHR","code_information":[{"code":"3003093","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":62.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":142.0,"discounted_cash":85.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":155.0,"discounted_cash":93.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":535.0,"discounted_cash":321.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":983.0,"discounted_cash":589.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":368.0,"discounted_cash":220.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":381.0,"discounted_cash":228.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX STACLOT, STACL","code_information":[{"code":"3003102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":535.0,"discounted_cash":321.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1158.0,"discounted_cash":694.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":782.0,"discounted_cash":469.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO LACOSAMIDE SERUM LACO","code_information":[{"code":"3003107","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":297.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO QUANT POSACONAZOLE, POSA","code_information":[{"code":"3003108","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80187","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"SO QUANTITATIVE ASSAY, QUANT, VEDOZ","code_information":[{"code":"3003109","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":367.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO VORICONAZOLE, VORI","code_information":[{"code":"3003110","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":939.0,"discounted_cash":563.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO APOLIPOPROTEIN B, APOLB","code_information":[{"code":"3003112","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":45.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":939.0,"discounted_cash":563.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTI XA, ARIXTRA","code_information":[{"code":"3003114","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85130","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":241.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO APOLIPOPROTEIN A1, APOAB","code_information":[{"code":"3003115","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO APOLIPOPROTEIN B, APOAB","code_information":[{"code":"3003116","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":79.0,"discounted_cash":47.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":96.0,"discounted_cash":57.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":51.0,"discounted_cash":30.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC DRUG SCREEN QUAN LAMOTRIGINE","code_information":[{"code":"3003125","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":136.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":423.0,"discounted_cash":253.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":332.0,"discounted_cash":199.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":423.0,"discounted_cash":253.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":49.0,"discounted_cash":29.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":181.0,"discounted_cash":108.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1438.0,"discounted_cash":862.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2683.0,"discounted_cash":1609.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":532.0,"discounted_cash":319.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":532.0,"discounted_cash":319.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":532.0,"discounted_cash":319.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SFMC MICROSATELLITE INSTABILITY","code_information":[{"code":"3003139","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1684.0,"discounted_cash":1010.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SFMC BRAF GENE","code_information":[{"code":"3003140","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":675.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1300.0,"discounted_cash":780.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ETHYLENE GLYCOL, ETGL","code_information":[{"code":"3003142","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO F13, FUNCTIONAL, FFX3F","code_information":[{"code":"3003143","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85290","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.0,"discounted_cash":409.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":422.0,"discounted_cash":253.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":422.0,"discounted_cash":253.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":181.0,"discounted_cash":108.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":422.0,"discounted_cash":253.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1787.0,"discounted_cash":1072.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1787.0,"discounted_cash":1072.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":58.0,"discounted_cash":34.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, IG5TS","code_information":[{"code":"3003161","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, IG5TC","code_information":[{"code":"3003162","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, NIFTC","code_information":[{"code":"3003163","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.0,"discounted_cash":254.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AINCS","code_information":[{"code":"3003164","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, IG5CS","code_information":[{"code":"3003165","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, NFHCS","code_information":[{"code":"3003166","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, NFLCS","code_information":[{"code":"3003167","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AINCC","code_information":[{"code":"3003168","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, IG5CC","code_information":[{"code":"3003169","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, NFHCC","code_information":[{"code":"3003170","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, NFLCC","code_information":[{"code":"3003171","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.0,"discounted_cash":1273.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AGNBS","code_information":[{"code":"3003172","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AMIBS","code_information":[{"code":"3003173","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AN1BS","code_information":[{"code":"3003174","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AN2BS","code_information":[{"code":"3003175","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, PC1BS","code_information":[{"code":"3003176","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, PCTBS","code_information":[{"code":"3003177","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AGNBC","code_information":[{"code":"3003178","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AMIBC","code_information":[{"code":"3003179","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AN1BC","code_information":[{"code":"3003180","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, AN2BC","code_information":[{"code":"3003181","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, PC1BC","code_information":[{"code":"3003182","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIBODY, PCTBC","code_information":[{"code":"3003183","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MUTATION ANALY, NPM1Q","code_information":[{"code":"3003190","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81310","type":"HCPCS"}],"standard_charges":[{"gross_charge":1565.0,"discounted_cash":939.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":305.0,"discounted_cash":183.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":782.0,"discounted_cash":469.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TRAMADOL, TRAM","code_information":[{"code":"3003196","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO GABAPENTIN, URINE, FGABA","code_information":[{"code":"3003197","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":373.0,"discounted_cash":223.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":695.0,"discounted_cash":417.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":361.0,"discounted_cash":216.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":297.0,"discounted_cash":178.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":292.0,"discounted_cash":175.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MS PROFILE, MSP3","code_information":[{"code":"3003205","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1300.0,"discounted_cash":780.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":104.0,"discounted_cash":62.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1184.0,"discounted_cash":710.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":104.0,"discounted_cash":62.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":4292.0,"discounted_cash":2575.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HEV IGG, HEVG","code_information":[{"code":"3003211","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":187.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":675.0,"discounted_cash":405.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":675.0,"discounted_cash":405.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO GALACTOCEREBROSIDASE, WBC, GALCW","code_information":[{"code":"3003216","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.0,"discounted_cash":1344.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":868.0,"discounted_cash":520.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":402.0,"discounted_cash":241.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":328.0,"discounted_cash":196.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 87426 CORONAVIRUS AG FIA","code_information":[{"code":"3003230","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"inpatient","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":132.0,"discounted_cash":79.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":145.0,"discounted_cash":87.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2419.0,"discounted_cash":1451.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":760.0,"discounted_cash":456.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1676.0,"discounted_cash":1005.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1565.0,"discounted_cash":939.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1676.0,"discounted_cash":1005.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1676.0,"discounted_cash":1005.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":767.0,"discounted_cash":460.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":604.0,"discounted_cash":362.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":312.0,"discounted_cash":187.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":662.0,"discounted_cash":397.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":613.0,"discounted_cash":367.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MUCOPOLYSACCHARIDES, MPSQU","code_information":[{"code":"3003252","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.0,"discounted_cash":793.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO URINE CREATININE, MPSQU","code_information":[{"code":"3003253","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTIMULLERIAN HORMONE, AMH1","code_information":[{"code":"3003256","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":269.0,"discounted_cash":161.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":516.0,"discounted_cash":309.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":604.0,"discounted_cash":362.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DEXAMETHASONE, FDXM","code_information":[{"code":"3003264","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":552.0,"discounted_cash":331.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":98.0,"discounted_cash":58.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":357.0,"discounted_cash":214.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":939.0,"discounted_cash":563.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2347.0,"discounted_cash":1408.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO URINE CREATININE, HMUOE","code_information":[{"code":"3003272","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO URINE CADMIUM, HMUOE","code_information":[{"code":"3003274","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":37.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO URINE LEAD, HMUOE","code_information":[{"code":"3003276","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":20.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":357.0,"discounted_cash":214.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO URINE CREATININE, CDUOE","code_information":[{"code":"3003278","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO URINE CADMIUM, CDUOE","code_information":[{"code":"3003279","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":531.0,"discounted_cash":318.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":531.0,"discounted_cash":318.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":701.0,"discounted_cash":420.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":358.0,"discounted_cash":214.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":358.0,"discounted_cash":214.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":870.0,"discounted_cash":522.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":131.0,"discounted_cash":78.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":131.0,"discounted_cash":78.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DRUG ASSAY AMIODARONE","code_information":[{"code":"3003305","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80151","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DRUG ASSAY FELBAMATE","code_information":[{"code":"3003308","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80167","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DRUG ASSAY LEFLUNOMIDE","code_information":[{"code":"3003310","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80193","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":402.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1120.0,"discounted_cash":672.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1676.0,"discounted_cash":1005.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC DRUG ASSAY SALICYLATE","code_information":[{"code":"3003314","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":126.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":190.0,"discounted_cash":114.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG ASSAY ACETAMINOPHEN","code_information":[{"code":"3003315","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.0,"discounted_cash":204.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":277.0,"discounted_cash":166.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DRUG ASSAY METHOTREXATE","code_information":[{"code":"3003316","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":201.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":324.0,"discounted_cash":194.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ETHYL ALCOHOL (ETHANOL)","code_information":[{"code":"3003317","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":475.0,"discounted_cash":285.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":386.0,"discounted_cash":231.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":586.0,"discounted_cash":351.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1130.0,"discounted_cash":678.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1130.0,"discounted_cash":678.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1714.0,"discounted_cash":1028.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":74.0,"discounted_cash":44.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":27.0,"discounted_cash":16.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":60.0,"discounted_cash":36.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":587.0,"discounted_cash":352.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":824.0,"discounted_cash":494.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":846.0,"discounted_cash":507.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2712.0,"discounted_cash":1627.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO OPIOID, CSMPU","code_information":[{"code":"3003331","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80364","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO BENZODIAZEPINES, CSMPU","code_information":[{"code":"3003332","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80347","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":347.0,"discounted_cash":208.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO AMPHETAMINES, CSMPU","code_information":[{"code":"3003334","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80326","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":31.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MURAMIDASE, MURA","code_information":[{"code":"3003336","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5029.0,"discounted_cash":3017.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":804.0,"discounted_cash":482.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":291.0,"discounted_cash":174.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":65.0,"discounted_cash":39.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":310.0,"discounted_cash":186.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1411.0,"discounted_cash":846.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1627.0,"discounted_cash":976.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1519.0,"discounted_cash":911.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1627.0,"discounted_cash":976.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":744.0,"discounted_cash":446.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":586.0,"discounted_cash":351.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":621.0,"discounted_cash":372.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":467.0,"discounted_cash":280.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, HBEL1","code_information":[{"code":"3003365","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":824.0,"discounted_cash":494.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1302.0,"discounted_cash":781.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":407.0,"discounted_cash":244.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":407.0,"discounted_cash":244.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":498.0,"discounted_cash":298.8,"setting":"inpatient","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":152.0,"discounted_cash":91.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":650.0,"discounted_cash":390.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":201.0,"discounted_cash":120.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":190.0,"discounted_cash":114.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":190.0,"discounted_cash":114.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":113.0,"discounted_cash":67.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":113.0,"discounted_cash":67.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":5560.0,"discounted_cash":3336.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5560.0,"discounted_cash":3336.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":334.0,"discounted_cash":200.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":134.0,"discounted_cash":80.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":47.0,"discounted_cash":28.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":47.0,"discounted_cash":28.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":38.0,"discounted_cash":22.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":23.0,"discounted_cash":13.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO METHYLPHENIDATE, MPHNU","code_information":[{"code":"3003393","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80360","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":759.0,"discounted_cash":455.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1519.0,"discounted_cash":911.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2604.0,"discounted_cash":1562.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":781.0,"discounted_cash":468.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1519.0,"discounted_cash":911.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":517.0,"discounted_cash":310.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":50.0,"discounted_cash":30.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":49.0,"discounted_cash":29.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":50.0,"discounted_cash":30.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":109.0,"discounted_cash":65.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":781.0,"discounted_cash":468.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CNT PANEL, CEP72","code_information":[{"code":"3003406","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":1689.0,"discounted_cash":1013.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":109.0,"discounted_cash":65.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1527.0,"discounted_cash":916.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":350.0,"discounted_cash":210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":434.0,"discounted_cash":260.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":616.0,"discounted_cash":369.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1214.0,"discounted_cash":728.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":102.0,"discounted_cash":61.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":102.0,"discounted_cash":61.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":102.0,"discounted_cash":61.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":565.0,"discounted_cash":339.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":374.0,"discounted_cash":224.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX METHYLENEDIOXYAMPHETAMINES, FAMCS","code_information":[{"code":"3003424","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":151.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":517.0,"discounted_cash":310.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":486.0,"discounted_cash":291.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFELX CANNABINOIDS, FCANS","code_information":[{"code":"3003427","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":281.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":453.0,"discounted_cash":271.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":514.0,"discounted_cash":308.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":185.0,"discounted_cash":111.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":198.0,"discounted_cash":118.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":166.0,"discounted_cash":99.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":569.0,"discounted_cash":341.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":616.0,"discounted_cash":369.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":369.0,"discounted_cash":221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":303.0,"discounted_cash":181.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":974.0,"discounted_cash":584.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":887.0,"discounted_cash":532.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3229.0,"discounted_cash":1937.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1826.0,"discounted_cash":1095.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3070.0,"discounted_cash":1842.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6944.0,"discounted_cash":4166.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6944.0,"discounted_cash":4166.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO TESTOSTERONE BIOAVAILABLE, FFTST","code_information":[{"code":"3003448","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84410","type":"HCPCS"}],"standard_charges":[{"gross_charge":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ASSAY FREE TESTOSTERONE","code_information":[{"code":"3003449","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":33.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":57.0,"discounted_cash":34.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":44.0,"discounted_cash":26.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1449.0,"discounted_cash":869.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MYCOBACTERIC ID, CTBID","code_information":[{"code":"3003455","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":261.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":92.0,"discounted_cash":55.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":92.0,"discounted_cash":55.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1528.0,"discounted_cash":916.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":407.0,"discounted_cash":244.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":407.0,"discounted_cash":244.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":404.0,"discounted_cash":242.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":404.0,"discounted_cash":242.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":977.0,"discounted_cash":586.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":404.0,"discounted_cash":242.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":790.0,"discounted_cash":474.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":404.0,"discounted_cash":242.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":390.0,"discounted_cash":234.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1510.0,"discounted_cash":906.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REFLEX NMOFC","code_information":[{"code":"3003472","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86053","type":"HCPCS"}],"standard_charges":[{"gross_charge":1279.0,"discounted_cash":767.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":49.0,"discounted_cash":29.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ELASTASE PANCREATIC FECAL QUANTITATIVE","code_information":[{"code":"3003474","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9114.0,"discounted_cash":5468.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1031.0,"discounted_cash":618.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1576.0,"discounted_cash":945.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1735.0,"discounted_cash":1041.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO DEXAMETHASONE, DEXA","code_information":[{"code":"3003491","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":299.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":976.0,"discounted_cash":585.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC GI PATHOGEN ARRAY","code_information":[{"code":"3003496","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1990.0,"discounted_cash":1194.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":141.0,"discounted_cash":84.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":99.0,"discounted_cash":59.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1408.0,"discounted_cash":844.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO FIBRINOGEN ANTIGEN, FIBAG","code_information":[{"code":"3003503","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.0,"discounted_cash":157.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":612.0,"discounted_cash":367.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":877.0,"discounted_cash":526.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO COPPER ASSAY, CUS1","code_information":[{"code":"3003506","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":34.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":50.0,"discounted_cash":30.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":604.0,"discounted_cash":362.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PROTOPORPHYRINS, PPFE","code_information":[{"code":"3003509","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.0,"discounted_cash":544.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC MITOCHONDRIAL (M2) EACH","code_information":[{"code":"3003534","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":55.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":859.0,"discounted_cash":515.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MONKEYPOX VIRUS, MPXDX","code_information":[{"code":"3003538","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8046.0,"discounted_cash":4827.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6136.0,"discounted_cash":3681.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":677.0,"discounted_cash":406.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":530.0,"discounted_cash":318.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1911.0,"discounted_cash":1146.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1508.0,"discounted_cash":904.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1013.0,"discounted_cash":607.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO IMMUNOFLUORESCENCE, PLA2I","code_information":[{"code":"3003547","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.0,"discounted_cash":607.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1400.0,"discounted_cash":840.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1013.0,"discounted_cash":607.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":342.0,"discounted_cash":205.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":202.0,"discounted_cash":121.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PNEUMOCYSTIS PCR, PNRP","code_information":[{"code":"3003552","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.0,"discounted_cash":270.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO LIPASE BF, LPSBF","code_information":[{"code":"3003553","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":397.0,"discounted_cash":238.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":522.0,"discounted_cash":313.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PHOSPHATIDYLETHANOL CONF, PETH","code_information":[{"code":"3003555","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.0,"discounted_cash":168.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":301.0,"discounted_cash":180.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12069.0,"discounted_cash":7241.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10057.0,"discounted_cash":6034.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8046.0,"discounted_cash":4827.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10057.0,"discounted_cash":6034.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10057.0,"discounted_cash":6034.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":31.0,"discounted_cash":18.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":119.0,"discounted_cash":71.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":31.0,"discounted_cash":18.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":793.0,"discounted_cash":475.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1212.0,"discounted_cash":727.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1212.0,"discounted_cash":727.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3625.0,"discounted_cash":2175.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7241.0,"discounted_cash":4344.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6437.0,"discounted_cash":3862.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7442.0,"discounted_cash":4465.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2683.0,"discounted_cash":1609.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2683.0,"discounted_cash":1609.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":9052.0,"discounted_cash":5431.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7644.0,"discounted_cash":4586.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6437.0,"discounted_cash":3862.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC TARGETED GENOMIC SEQ ANALYS","code_information":[{"code":"3003591","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81455","type":"HCPCS"}],"standard_charges":[{"gross_charge":5448.0,"discounted_cash":3268.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3821.0,"discounted_cash":2292.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3821.0,"discounted_cash":2292.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1951.0,"discounted_cash":1170.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1951.0,"discounted_cash":1170.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2139.0,"discounted_cash":1283.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2008.0,"discounted_cash":1204.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2008.0,"discounted_cash":1204.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":95.0,"discounted_cash":57.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":95.0,"discounted_cash":57.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":95.0,"discounted_cash":57.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":226.0,"discounted_cash":135.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":71.0,"discounted_cash":42.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":71.0,"discounted_cash":42.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CREATININE UR, CRCRU","code_information":[{"code":"3003619","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHROMIUM URINE, CRCRU","code_information":[{"code":"3003620","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":240.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CREATININE UR, NIUCR","code_information":[{"code":"3003621","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":133.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO NICKEL, NIUCR","code_information":[{"code":"3003622","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83885","type":"HCPCS"}],"standard_charges":[{"gross_charge":1051.0,"discounted_cash":630.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO NEUROCONDRIN CBA, NCDCS","code_information":[{"code":"3003632","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":844.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO AP3B2 CBA, APBCS","code_information":[{"code":"3003633","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":844.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1408.0,"discounted_cash":844.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1408.0,"discounted_cash":844.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1408.0,"discounted_cash":844.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1582.0,"discounted_cash":949.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, REVE2","code_information":[{"code":"3003651","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":507.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HEMOGLOBIN ELECTROPHORESIS, REVE2","code_information":[{"code":"3003652","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":845.0,"discounted_cash":507.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1185.0,"discounted_cash":711.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO INTERLEUKIN-6, IL6DX","code_information":[{"code":"3003654","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":72.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":37.0,"discounted_cash":22.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":160.0,"discounted_cash":96.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":514.0,"discounted_cash":308.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":258.0,"discounted_cash":154.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANDROSTENEDIONE, FANDR","code_information":[{"code":"3003663","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.0,"discounted_cash":178.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3718.0,"discounted_cash":2230.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2048.0,"discounted_cash":1228.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2048.0,"discounted_cash":1228.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2245.0,"discounted_cash":1347.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5230.0,"discounted_cash":3138.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":628.0,"discounted_cash":376.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":522.0,"discounted_cash":313.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHLAMYDIA AB, CHLAP","code_information":[{"code":"3003671","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":22.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHLAMYDIA AB, CHLAP","code_information":[{"code":"3003672","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":22.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":785.0,"discounted_cash":471.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1046.0,"discounted_cash":627.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1046.0,"discounted_cash":627.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":141.0,"discounted_cash":84.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":301.0,"discounted_cash":180.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO BARBITURATES, FBCFS","code_information":[{"code":"3003681","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":485.0,"discounted_cash":291.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":237.0,"discounted_cash":142.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":237.0,"discounted_cash":142.2,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":26.0,"discounted_cash":15.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":84.0,"discounted_cash":50.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":309.0,"discounted_cash":185.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":23.0,"discounted_cash":13.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":48.0,"discounted_cash":28.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":532.0,"discounted_cash":319.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":70.0,"discounted_cash":42.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO GALACTOSE IGE, ALGAL","code_information":[{"code":"3003694","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":352.0,"discounted_cash":211.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":44.0,"discounted_cash":26.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":194.0,"discounted_cash":116.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SFMC TREPONEMA PALLIDUM","code_information":[{"code":"3003701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHLAMYDIA AB, CHLG","code_information":[{"code":"3003702","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":38.0,"discounted_cash":22.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1134.0,"discounted_cash":680.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1134.0,"discounted_cash":680.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":107.0,"discounted_cash":64.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":312.0,"discounted_cash":187.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":521.0,"discounted_cash":312.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":296.0,"discounted_cash":177.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":296.0,"discounted_cash":177.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":154.0,"discounted_cash":92.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":68.0,"discounted_cash":40.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":68.0,"discounted_cash":40.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61.0,"discounted_cash":36.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":70.0,"discounted_cash":42.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":156.0,"discounted_cash":93.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":156.0,"discounted_cash":93.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":491.0,"discounted_cash":294.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":491.0,"discounted_cash":294.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":76.0,"discounted_cash":45.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":76.0,"discounted_cash":45.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":24.0,"discounted_cash":14.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO SEDATIVE HYP, BNZU","code_information":[{"code":"3003733","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80368","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":197.0,"discounted_cash":118.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO NATRIURETIC PEPTIDE, PBNP1","code_information":[{"code":"3003735","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":255.0,"discounted_cash":153.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1577.0,"discounted_cash":946.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":711.0,"discounted_cash":426.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1773.0,"discounted_cash":1063.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":418.0,"discounted_cash":250.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":273.0,"discounted_cash":163.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3320.0,"discounted_cash":1992.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":50.0,"discounted_cash":30.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MITOTANE (LYSODREN), FMITO","code_information":[{"code":"3003743","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MUCOPOLYSACCHARIDOSIS, MPSBS","code_information":[{"code":"3003744","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83864","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.0,"discounted_cash":121.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CREATININE URINE, NIUCR","code_information":[{"code":"3003745","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1047.0,"discounted_cash":628.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":296.0,"discounted_cash":177.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1478.0,"discounted_cash":886.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":770.0,"discounted_cash":462.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":591.0,"discounted_cash":354.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":707.0,"discounted_cash":424.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":707.0,"discounted_cash":424.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":59.0,"discounted_cash":35.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CU INDEX, FCUIX","code_information":[{"code":"3003758","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86343","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":378.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO FIBRINOLYSINS SCREEN, CHF8P","code_information":[{"code":"3003759","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":454.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":591.0,"discounted_cash":354.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SFMC TRICHOMONAS VAGINALIS PCR","code_information":[{"code":"3003776","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":157.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CSF MENINGITIS ENCEPHALITIS PANEL","code_information":[{"code":"3003803","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":1166.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO LIPOPROTEIN A, LIPA1","code_information":[{"code":"3003804","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO COLUMN CHROMOTOGRAPHY, HEX4","code_information":[{"code":"3003805","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":811.0,"discounted_cash":486.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CREATININE UR, HEX4","code_information":[{"code":"3003806","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":79.0,"discounted_cash":47.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":72.0,"discounted_cash":43.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3148.0,"discounted_cash":1888.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC RESPIRATORY SYNCYTIAL VIRUS","code_information":[{"code":"3003810","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87634","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.0,"discounted_cash":214.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":173.0,"discounted_cash":103.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PORPHOBILINOGEN ASSAY, PQNRU","code_information":[{"code":"3003812","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84110","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":29.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PORPHYRINS ASSAY, PQNRU","code_information":[{"code":"3003813","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":51.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":613.0,"discounted_cash":367.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":630.0,"discounted_cash":378.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1380.0,"discounted_cash":828.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":398.0,"discounted_cash":238.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":374.0,"discounted_cash":224.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1380.0,"discounted_cash":828.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":374.0,"discounted_cash":224.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1380.0,"discounted_cash":828.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":111.0,"discounted_cash":66.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":110.0,"discounted_cash":66.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":110.0,"discounted_cash":66.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":268.0,"discounted_cash":160.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":256.0,"discounted_cash":153.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHERRY IGE, CHER","code_information":[{"code":"3003829","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":12.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":20.0,"discounted_cash":12.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":20.0,"discounted_cash":12.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ACETYLCHOLINESTERASE ASSAY, ACHE","code_information":[{"code":"3003832","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82013","type":"HCPCS"}],"standard_charges":[{"gross_charge":315.0,"discounted_cash":189.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHICKPEA IGE, CHXP","code_information":[{"code":"3003833","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":12.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":20.0,"discounted_cash":12.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":41.0,"discounted_cash":24.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":41.0,"discounted_cash":24.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":36.0,"discounted_cash":21.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1191.0,"discounted_cash":714.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":346.0,"discounted_cash":207.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":734.0,"discounted_cash":440.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":569.0,"discounted_cash":341.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO NOROVIRUS PCR, LNORO","code_information":[{"code":"3003850","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":156.0,"discounted_cash":93.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1042.0,"discounted_cash":625.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1042.0,"discounted_cash":625.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":381.0,"discounted_cash":228.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":179.0,"discounted_cash":107.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":817.0,"discounted_cash":490.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":381.0,"discounted_cash":228.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":297.0,"discounted_cash":178.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":206.0,"discounted_cash":123.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":171.0,"discounted_cash":102.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":171.0,"discounted_cash":102.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":240.0,"discounted_cash":144.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":149.0,"discounted_cash":89.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":144.0,"discounted_cash":86.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO FLOW CYTOMETRY, HAEV1","code_information":[{"code":"3003872","type":"CDM"},{"code":"0300","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1362.0,"discounted_cash":817.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":332.0,"discounted_cash":199.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1329.0,"discounted_cash":797.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":238.0,"discounted_cash":142.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":18.0,"discounted_cash":10.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4034.0,"discounted_cash":2420.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":569.0,"discounted_cash":341.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":73.0,"discounted_cash":43.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":642.0,"discounted_cash":385.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":642.0,"discounted_cash":385.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1742.0,"discounted_cash":1045.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1742.0,"discounted_cash":1045.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":47.0,"discounted_cash":28.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":47.0,"discounted_cash":28.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":486.0,"discounted_cash":291.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1131.0,"discounted_cash":678.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":486.0,"discounted_cash":291.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":257.0,"discounted_cash":154.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":109.0,"discounted_cash":65.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":265.0,"discounted_cash":159.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":214.0,"discounted_cash":128.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":342.0,"discounted_cash":205.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":146.0,"discounted_cash":87.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1453.0,"discounted_cash":871.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":284.0,"discounted_cash":170.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":455.0,"discounted_cash":273.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1284.0,"discounted_cash":770.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":163.0,"discounted_cash":97.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":237.0,"discounted_cash":142.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":713.0,"discounted_cash":427.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":86.0,"discounted_cash":51.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":123.0,"discounted_cash":73.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":48.0,"discounted_cash":28.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":330.0,"discounted_cash":198.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":48.0,"discounted_cash":28.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1394.0,"discounted_cash":836.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1834.0,"discounted_cash":1100.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":19.0,"discounted_cash":11.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1274.0,"discounted_cash":764.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1274.0,"discounted_cash":764.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":21.0,"discounted_cash":12.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1430.0,"discounted_cash":858.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1430.0,"discounted_cash":858.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":258.0,"discounted_cash":154.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":258.0,"discounted_cash":154.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":41.0,"discounted_cash":24.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":18.0,"discounted_cash":10.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MUSHROOM IGE, MUSH","code_information":[{"code":"3003927","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":10.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO AMOXCILLOYL IGE, AMOXY","code_information":[{"code":"3003928","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":10.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CUCUMBER IGE, CUKE","code_information":[{"code":"3003929","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":10.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1284.0,"discounted_cash":770.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1284.0,"discounted_cash":770.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":348.0,"discounted_cash":208.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1284.0,"discounted_cash":770.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":147.0,"discounted_cash":88.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":388.0,"discounted_cash":232.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1284.0,"discounted_cash":770.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":91.0,"discounted_cash":54.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2263.0,"discounted_cash":1357.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":220.0,"discounted_cash":132.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1333.0,"discounted_cash":799.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":682.0,"discounted_cash":409.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":682.0,"discounted_cash":409.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":682.0,"discounted_cash":409.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":682.0,"discounted_cash":409.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1333.0,"discounted_cash":799.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO WATERMELON IGE, WMEL","code_information":[{"code":"3003948","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":10.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CYSTATIN C","code_information":[{"code":"3003949","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":30.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1192.0,"discounted_cash":715.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":110.0,"discounted_cash":66.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":194.0,"discounted_cash":116.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO HEPARIN ASSAY, ARIXTRA","code_information":[{"code":"3003953","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.0,"discounted_cash":481.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":719.0,"discounted_cash":431.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1079.0,"discounted_cash":647.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":324.0,"discounted_cash":194.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1258.0,"discounted_cash":754.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":306.0,"discounted_cash":183.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":54.0,"discounted_cash":32.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1120.0,"discounted_cash":672.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":876.0,"discounted_cash":525.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2362.0,"discounted_cash":1417.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1121.0,"discounted_cash":672.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTI-MULLERIAN HORMONE","code_information":[{"code":"3003972","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82166","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1170.0,"discounted_cash":702.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":188.0,"discounted_cash":112.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":188.0,"discounted_cash":112.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":288.0,"discounted_cash":172.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":16.0,"discounted_cash":9.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":16.0,"discounted_cash":9.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":16.0,"discounted_cash":9.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":448.0,"discounted_cash":268.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":448.0,"discounted_cash":268.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":448.0,"discounted_cash":268.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":551.0,"discounted_cash":330.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2821.0,"discounted_cash":1692.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ALKALINE PHOSPHATASE, ALKP","code_information":[{"code":"3003989","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":58.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":98.0,"discounted_cash":58.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":196.0,"discounted_cash":117.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":181.0,"discounted_cash":108.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":13658.0,"discounted_cash":8194.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1751.0,"discounted_cash":1050.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PNEUMOCYSTIS PCR, PNRP","code_information":[{"code":"3003996","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87594","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":235.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6129.0,"discounted_cash":3677.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":554.0,"discounted_cash":332.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":554.0,"discounted_cash":332.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":554.0,"discounted_cash":332.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":183.0,"discounted_cash":109.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":263.0,"discounted_cash":157.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":657.0,"discounted_cash":394.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":438.0,"discounted_cash":262.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2031.0,"discounted_cash":1218.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":246.0,"discounted_cash":147.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":77.0,"discounted_cash":46.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CLOMIPRAMINE, CLOM","code_information":[{"code":"3004009","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO LIDOCAINE, LID","code_information":[{"code":"3004011","type":"CDM"},{"code":"0300","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":455.0,"discounted_cash":273.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3011.0,"discounted_cash":1806.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":350.0,"discounted_cash":210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":16.0,"discounted_cash":9.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":139.0,"discounted_cash":83.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":130.0,"discounted_cash":78.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":155.0,"discounted_cash":93.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":155.0,"discounted_cash":93.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":220.0,"discounted_cash":132.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":220.0,"discounted_cash":132.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":140.0,"discounted_cash":84.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":372.0,"discounted_cash":223.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":167.0,"discounted_cash":100.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":167.0,"discounted_cash":100.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":756.0,"discounted_cash":453.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":756.0,"discounted_cash":453.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":560.0,"discounted_cash":336.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":560.0,"discounted_cash":336.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":560.0,"discounted_cash":336.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ANTINUCLEAR ANTIBODIES, FSCPR","code_information":[{"code":"3004097","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO IMMUNOASSAY NONAB, FSCPR","code_information":[{"code":"3004098","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":60.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":156.0,"discounted_cash":93.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":156.0,"discounted_cash":93.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":104.0,"discounted_cash":62.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":333.0,"discounted_cash":199.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":193.0,"discounted_cash":115.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":193.0,"discounted_cash":115.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":648.0,"discounted_cash":388.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1278.0,"discounted_cash":766.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2451.0,"discounted_cash":1470.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":70.0,"discounted_cash":42.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":206.0,"discounted_cash":123.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":206.0,"discounted_cash":123.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":272.0,"discounted_cash":163.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO ASSAY OF PROLACIN, PLPMA","code_information":[{"code":"3004118","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.0,"discounted_cash":122.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":62.0,"discounted_cash":37.2,"setting":"inpatient","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":58.0,"discounted_cash":34.8,"setting":"outpatient","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":96.0,"discounted_cash":57.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":87.0,"discounted_cash":52.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":79.0,"discounted_cash":47.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":404.0,"discounted_cash":242.4,"setting":"inpatient","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"},{"gross_charge":308.0,"discounted_cash":184.8,"setting":"outpatient","modifier_code":["QW"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is presented in the standard charge value. | Modifier QW: Clia waived test"}]},{"description":"HC WET MOUNTS, INCLUDES PREP OF SPECIMEN","code_information":[{"code":"3090010","type":"CDM"},{"code":"0300","type":"RC"},{"code":"Q0111","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.0,"discounted_cash":63.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC COAGULATION TIME, ACTIVATED","code_information":[{"code":"3090014","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":93.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":142.0,"discounted_cash":85.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":192.0,"discounted_cash":115.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":180.0,"discounted_cash":108.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":164.0,"discounted_cash":98.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":43.0,"discounted_cash":25.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ROM PLUS PP12 & AFP","code_information":[{"code":"3090018","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":164.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":274.0,"discounted_cash":164.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SKIN TEST - TUBERCULOSIS, INTRADERMAL","code_information":[{"code":"3090019","type":"CDM"},{"code":"0309","type":"RC"},{"code":"86580","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":75.0,"discounted_cash":45.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PROTHROMBIN TIME-FINGER STICK","code_information":[{"code":"3090020","type":"CDM"},{"code":"0300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC POCT INFLUENZA A & B","code_information":[{"code":"3090031","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87804","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.0,"discounted_cash":163.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC POCT MONO","code_information":[{"code":"3090032","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":125.0,"discounted_cash":75.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC POCT HEMOGLOBIN GLYCOSYLATED HBA1C","code_information":[{"code":"3090038","type":"CDM"},{"code":"0300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":69.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BONE MARROW, SMEAR INTERPRETATION","code_information":[{"code":"3100002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":540.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CYTO SMEAR, NON-GYN","code_information":[{"code":"3100003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":303.0,"discounted_cash":181.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":276.0,"discounted_cash":165.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CYTO SMEAR, CONCENTRATION TECHIQUE","code_information":[{"code":"3100004","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":194.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":296.0,"discounted_cash":177.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CYTOPATHOLOGY, CELL ENHANCEMENT TECH","code_information":[{"code":"3100005","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":207.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":313.0,"discounted_cash":187.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":273.0,"discounted_cash":163.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":248.0,"discounted_cash":148.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CYTOPATHOLOGY, BETHESDA, MANUAL","code_information":[{"code":"3100010","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88164","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":123.0,"discounted_cash":73.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":365.0,"discounted_cash":219.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":294.0,"discounted_cash":176.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CYTOPATHOLOGY, FNA EVALUATION","code_information":[{"code":"3100012","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.0,"discounted_cash":271.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":413.0,"discounted_cash":247.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":278.0,"discounted_cash":166.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":255.0,"discounted_cash":153.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":933.0,"discounted_cash":559.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":710.0,"discounted_cash":426.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC CULTURE FOR CHROMOS ANALYSIS","code_information":[{"code":"3100016","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":758.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":963.0,"discounted_cash":577.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1257.0,"discounted_cash":754.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1149.0,"discounted_cash":689.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1984.0,"discounted_cash":1190.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1814.0,"discounted_cash":1088.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1023.0,"discounted_cash":613.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1766.0,"discounted_cash":1059.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1345.0,"discounted_cash":807.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":960.0,"discounted_cash":576.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":877.0,"discounted_cash":526.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1507.0,"discounted_cash":904.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1380.0,"discounted_cash":828.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1260.0,"discounted_cash":756.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1153.0,"discounted_cash":691.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":410.0,"discounted_cash":246.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":375.0,"discounted_cash":225.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":642.0,"discounted_cash":385.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":587.0,"discounted_cash":352.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":561.0,"discounted_cash":336.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":514.0,"discounted_cash":308.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":592.0,"discounted_cash":355.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":540.0,"discounted_cash":324.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":388.0,"discounted_cash":232.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":353.0,"discounted_cash":211.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":549.0,"discounted_cash":329.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":501.0,"discounted_cash":300.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":468.0,"discounted_cash":280.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":429.0,"discounted_cash":257.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED CYTOGENETIC STUDY","code_information":[{"code":"3100034","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88299","type":"HCPCS"}],"standard_charges":[{"gross_charge":2579.0,"discounted_cash":1547.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2361.0,"discounted_cash":1416.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":178.0,"discounted_cash":106.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":289.0,"discounted_cash":173.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":564.0,"discounted_cash":338.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":516.0,"discounted_cash":309.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":581.0,"discounted_cash":348.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":815.0,"discounted_cash":489.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":744.0,"discounted_cash":446.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1768.0,"discounted_cash":1060.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1521.0,"discounted_cash":912.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DECALCIFICATION PROC","code_information":[{"code":"3100041","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":106.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SPECIAL STAINS, GRP 1","code_information":[{"code":"3100042","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC SPECIAL STAIN GRP 2","code_information":[{"code":"3100043","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.0,"discounted_cash":163.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":249.0,"discounted_cash":149.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":392.0,"discounted_cash":235.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":357.0,"discounted_cash":214.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":901.0,"discounted_cash":540.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CONSULT/REPORT, REFER SLIDES","code_information":[{"code":"3100046","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":25.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1407.0,"discounted_cash":844.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1287.0,"discounted_cash":772.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1553.0,"discounted_cash":931.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1422.0,"discounted_cash":853.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PATH CONSULTATION DURING SURGERY","code_information":[{"code":"3100049","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88329","type":"HCPCS"}],"standard_charges":[{"gross_charge":218.0,"discounted_cash":130.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":201.0,"discounted_cash":120.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC FROZEN SECTION","code_information":[{"code":"3100050","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":346.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":527.0,"discounted_cash":316.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ADDITIONAL FROZEN SECTIONS","code_information":[{"code":"3100051","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":366.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":557.0,"discounted_cash":334.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":901.0,"discounted_cash":540.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":180.0,"discounted_cash":108.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":165.0,"discounted_cash":99.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DIRECT IMMUNOFLUOR (TISSUE)","code_information":[{"code":"3100055","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":341.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":520.0,"discounted_cash":312.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ELECTRON MICROSCOPY; DX","code_information":[{"code":"3100057","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":4275.0,"discounted_cash":2565.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":3260.0,"discounted_cash":1956.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MORPHOMETRIC ANALY HISTOCHEM","code_information":[{"code":"3100058","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":273.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":347.0,"discounted_cash":208.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":633.0,"discounted_cash":379.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":577.0,"discounted_cash":346.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":749.0,"discounted_cash":449.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":685.0,"discounted_cash":411.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":940.0,"discounted_cash":564.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":718.0,"discounted_cash":430.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC THIN PREP PAP,SCREENING","code_information":[{"code":"3100063","type":"CDM"},{"code":"0311","type":"RC"},{"code":"G0143","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":215.0,"discounted_cash":129.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PAP SMEAR,SCREENING","code_information":[{"code":"3100064","type":"CDM"},{"code":"0311","type":"RC"},{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":79.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1093.0,"discounted_cash":655.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1001.0,"discounted_cash":600.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":188.0,"discounted_cash":112.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":144.0,"discounted_cash":86.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC ARCHIVAL TISSUE MOLECULAR EXAM","code_information":[{"code":"3100068","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88363","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":151.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":202.0,"discounted_cash":121.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MICRODISSECTION, MANUAL","code_information":[{"code":"3100070","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":1657.0,"discounted_cash":994.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1515.0,"discounted_cash":909.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":431.0,"discounted_cash":258.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":132.0,"discounted_cash":79.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":602.0,"discounted_cash":361.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":277.0,"discounted_cash":166.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":158.0,"discounted_cash":94.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":142.0,"discounted_cash":85.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":901.0,"discounted_cash":540.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1712.0,"discounted_cash":1027.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1565.0,"discounted_cash":939.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1984.0,"discounted_cash":1190.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1814.0,"discounted_cash":1088.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1023.0,"discounted_cash":613.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1023.0,"discounted_cash":613.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1471.0,"discounted_cash":882.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1345.0,"discounted_cash":807.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1190.0,"discounted_cash":714.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":388.0,"discounted_cash":232.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":353.0,"discounted_cash":211.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED CYTOGENETIC STUDY","code_information":[{"code":"3100086","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1563.0,"discounted_cash":937.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1430.0,"discounted_cash":858.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC UNLISTED CYTOGENETIC STUDY","code_information":[{"code":"3100087","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88299","type":"HCPCS"}],"standard_charges":[{"gross_charge":2579.0,"discounted_cash":1547.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":2361.0,"discounted_cash":1416.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":431.0,"discounted_cash":258.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":351.0,"discounted_cash":210.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":602.0,"discounted_cash":361.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":493.0,"discounted_cash":295.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BONE MARROW, SMEAR INTERPRETATION","code_information":[{"code":"3100100","type":"CDM"},{"code":"0310","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.0,"discounted_cash":540.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":303.0,"discounted_cash":181.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":276.0,"discounted_cash":165.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":245.0,"discounted_cash":147.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1507.0,"discounted_cash":904.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":1380.0,"discounted_cash":828.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":431.0,"discounted_cash":258.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":592.0,"discounted_cash":355.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":540.0,"discounted_cash":324.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":388.0,"discounted_cash":232.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":353.0,"discounted_cash":211.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":195.0,"discounted_cash":117.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":178.0,"discounted_cash":106.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":443.0,"discounted_cash":265.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":564.0,"discounted_cash":338.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":516.0,"discounted_cash":309.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":690.0,"discounted_cash":414.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":631.0,"discounted_cash":378.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":853.0,"discounted_cash":511.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":780.0,"discounted_cash":468.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1853.0,"discounted_cash":1111.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":1594.0,"discounted_cash":956.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":177.0,"discounted_cash":106.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":161.0,"discounted_cash":96.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":288.0,"discounted_cash":172.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":288.0,"discounted_cash":172.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":392.0,"discounted_cash":235.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":357.0,"discounted_cash":214.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":892.0,"discounted_cash":535.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":611.0,"discounted_cash":366.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":557.0,"discounted_cash":334.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":569.0,"discounted_cash":341.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":520.0,"discounted_cash":312.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC DIRECT IMMUNOFLUOR (TISSUE)","code_information":[{"code":"3100121","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.0,"discounted_cash":341.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":520.0,"discounted_cash":312.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":577.0,"discounted_cash":346.2,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":792.0,"discounted_cash":475.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":724.0,"discounted_cash":434.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":940.0,"discounted_cash":564.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":718.0,"discounted_cash":430.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":940.0,"discounted_cash":564.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":718.0,"discounted_cash":430.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":940.0,"discounted_cash":564.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":718.0,"discounted_cash":430.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":272.0,"discounted_cash":163.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":263.0,"discounted_cash":157.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":388.0,"discounted_cash":232.8,"setting":"inpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 91: Repeat Clinical Diagnostic Laboratory Test"},{"gross_charge":353.0,"discounted_cash":211.8,"setting":"outpatient","modifier_code":["91"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":602.0,"discounted_cash":361.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":551.0,"discounted_cash":330.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":245.0,"discounted_cash":147.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":431.0,"discounted_cash":258.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":142.0,"discounted_cash":85.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":431.0,"discounted_cash":258.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":132.0,"discounted_cash":79.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":121.0,"discounted_cash":72.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":431.0,"discounted_cash":258.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":158.0,"discounted_cash":94.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":142.0,"discounted_cash":85.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":602.0,"discounted_cash":361.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":551.0,"discounted_cash":330.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":245.0,"discounted_cash":147.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":431.0,"discounted_cash":258.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":393.0,"discounted_cash":235.8,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":602.0,"discounted_cash":361.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":551.0,"discounted_cash":330.6,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":245.0,"discounted_cash":147.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":602.0,"discounted_cash":361.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":551.0,"discounted_cash":330.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MOLECULAR CYTOGENETIC INTERPRETATION (FAML)","code_information":[{"code":"3100156","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":275.0,"discounted_cash":165.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":209.0,"discounted_cash":125.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":500.0,"discounted_cash":300.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":431.0,"discounted_cash":258.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":524.0,"discounted_cash":314.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":480.0,"discounted_cash":288.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":920.0,"discounted_cash":552.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6203.0,"discounted_cash":3721.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":5675.0,"discounted_cash":3405.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":602.0,"discounted_cash":361.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":431.0,"discounted_cash":258.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":232.0,"discounted_cash":139.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":232.0,"discounted_cash":139.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":225.0,"discounted_cash":135.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":275.0,"discounted_cash":165.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":265.0,"discounted_cash":159.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":275.0,"discounted_cash":165.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":265.0,"discounted_cash":159.0,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1147.0,"discounted_cash":688.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1114.0,"discounted_cash":668.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1147.0,"discounted_cash":688.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 59: Distinct Procedural Service"},{"gross_charge":1114.0,"discounted_cash":668.4,"setting":"outpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":1408.0,"discounted_cash":844.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1365.0,"discounted_cash":819.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":50.0,"discounted_cash":30.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":50.0,"discounted_cash":30.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":973.0,"discounted_cash":583.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1801.0,"discounted_cash":1080.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1644.0,"discounted_cash":986.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1644.0,"discounted_cash":986.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3338.0,"discounted_cash":2002.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":421.0,"discounted_cash":252.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":421.0,"discounted_cash":252.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":362.0,"discounted_cash":217.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":369.0,"discounted_cash":221.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":369.0,"discounted_cash":221.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":848.0,"discounted_cash":508.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":848.0,"discounted_cash":508.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1914.0,"discounted_cash":1148.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1914.0,"discounted_cash":1148.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":531.0,"discounted_cash":318.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":531.0,"discounted_cash":318.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":459.0,"discounted_cash":275.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":459.0,"discounted_cash":275.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":421.0,"discounted_cash":252.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":421.0,"discounted_cash":252.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":376.0,"discounted_cash":225.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":522.0,"discounted_cash":313.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC IMMUNOFLUOR ANTB ADDTL STAIN","code_information":[{"code":"3100206","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":369.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":734.0,"discounted_cash":440.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":5706.0,"discounted_cash":3423.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":491.0,"discounted_cash":294.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1306.0,"discounted_cash":783.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1068.0,"discounted_cash":640.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":848.0,"discounted_cash":508.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":848.0,"discounted_cash":508.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1956.0,"discounted_cash":1173.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1157.0,"discounted_cash":694.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1157.0,"discounted_cash":694.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":990.0,"discounted_cash":594.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6708.0,"discounted_cash":4024.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CHROMOSOMAL MICROARRAY, CMAPC","code_information":[{"code":"3100237","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":6708.0,"discounted_cash":4024.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8029.0,"discounted_cash":4817.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5373.0,"discounted_cash":3223.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1676.0,"discounted_cash":1005.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1438.0,"discounted_cash":862.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2683.0,"discounted_cash":1609.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4024.0,"discounted_cash":2414.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1654.0,"discounted_cash":992.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":496.0,"discounted_cash":297.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8945.0,"discounted_cash":5367.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2683.0,"discounted_cash":1609.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4918.0,"discounted_cash":2950.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":11069.0,"discounted_cash":6641.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4918.0,"discounted_cash":2950.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6708.0,"discounted_cash":4024.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8051.0,"discounted_cash":4830.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1565.0,"discounted_cash":939.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":871.0,"discounted_cash":522.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":871.0,"discounted_cash":522.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO BRCA1-BRCA2, BRST6","code_information":[{"code":"3100271","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":5046.0,"discounted_cash":3027.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO CDH1, BRST6","code_information":[{"code":"3100272","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":634.0,"discounted_cash":380.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PTEN, BRST6","code_information":[{"code":"3100273","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.0,"discounted_cash":807.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":677.0,"discounted_cash":406.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":677.0,"discounted_cash":406.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":996.0,"discounted_cash":597.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":996.0,"discounted_cash":597.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO PROINSULIN INTACT, FPINS","code_information":[{"code":"3100298","type":"CDM"},{"code":"0310","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":508.0,"discounted_cash":304.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5308.0,"discounted_cash":3184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3131.0,"discounted_cash":1878.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1565.0,"discounted_cash":939.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1745.0,"discounted_cash":1047.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2683.0,"discounted_cash":1609.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4472.0,"discounted_cash":2683.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO REDUCING SUBSTANCE UREDF","code_information":[{"code":"3100343","type":"CDM"},{"code":"0300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1134.0,"discounted_cash":680.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC MAAA NEPHROCHECK","code_information":[{"code":"3100345","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81599","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":345.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2661.0,"discounted_cash":1596.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":819.0,"discounted_cash":491.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":819.0,"discounted_cash":491.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1836.0,"discounted_cash":1101.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1232.0,"discounted_cash":739.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO FIBROBLAST CULTURE FIBR","code_information":[{"code":"3100351","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88233","type":"HCPCS"}],"standard_charges":[{"gross_charge":2350.0,"discounted_cash":1410.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8945.0,"discounted_cash":5367.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8603.0,"discounted_cash":5161.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1297.0,"discounted_cash":778.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1217.0,"discounted_cash":730.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1182.0,"discounted_cash":709.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2460.0,"discounted_cash":1476.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6150.0,"discounted_cash":3690.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8945.0,"discounted_cash":5367.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1721.0,"discounted_cash":1032.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1721.0,"discounted_cash":1032.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3127.0,"discounted_cash":1876.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2725.0,"discounted_cash":1635.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1887.0,"discounted_cash":1132.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2757.0,"discounted_cash":1654.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2788.0,"discounted_cash":1672.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":792.0,"discounted_cash":475.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8945.0,"discounted_cash":5367.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5815.0,"discounted_cash":3489.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3019.0,"discounted_cash":1811.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2012.0,"discounted_cash":1207.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1025.0,"discounted_cash":615.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1521.0,"discounted_cash":912.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1563.0,"discounted_cash":937.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1563.0,"discounted_cash":937.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":4679.0,"discounted_cash":2807.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5815.0,"discounted_cash":3489.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5815.0,"discounted_cash":3489.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":11180.0,"discounted_cash":6708.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1958.0,"discounted_cash":1174.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2014.0,"discounted_cash":1208.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6029.0,"discounted_cash":3617.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":13193.0,"discounted_cash":7915.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8051.0,"discounted_cash":4830.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":937.0,"discounted_cash":562.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":937.0,"discounted_cash":562.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":910.0,"discounted_cash":546.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":999.0,"discounted_cash":599.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":999.0,"discounted_cash":599.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":979.0,"discounted_cash":587.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1565.0,"discounted_cash":939.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1460.0,"discounted_cash":876.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":188.0,"discounted_cash":112.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":594.0,"discounted_cash":356.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":881.0,"discounted_cash":528.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":966.0,"discounted_cash":579.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":907.0,"discounted_cash":544.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":907.0,"discounted_cash":544.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2714.0,"discounted_cash":1628.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":567.0,"discounted_cash":340.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8945.0,"discounted_cash":5367.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8720.0,"discounted_cash":5232.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1720.0,"discounted_cash":1032.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":974.0,"discounted_cash":584.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1636.0,"discounted_cash":981.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1723.0,"discounted_cash":1033.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":472.0,"discounted_cash":283.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2291.0,"discounted_cash":1374.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":610.0,"discounted_cash":366.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":537.0,"discounted_cash":322.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":645.0,"discounted_cash":387.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1787.0,"discounted_cash":1072.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1565.0,"discounted_cash":939.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7555.0,"discounted_cash":4533.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5308.0,"discounted_cash":3184.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1394.0,"discounted_cash":836.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":105.0,"discounted_cash":63.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4147.0,"discounted_cash":2488.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4472.0,"discounted_cash":2683.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5366.0,"discounted_cash":3219.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":817.0,"discounted_cash":490.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1084.0,"discounted_cash":650.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2347.0,"discounted_cash":1408.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2347.0,"discounted_cash":1408.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1119.0,"discounted_cash":671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9838.0,"discounted_cash":5902.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2191.0,"discounted_cash":1314.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1745.0,"discounted_cash":1047.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2205.0,"discounted_cash":1323.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":519.0,"discounted_cash":311.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1342.0,"discounted_cash":805.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2661.0,"discounted_cash":1596.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1565.0,"discounted_cash":939.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10062.0,"discounted_cash":6037.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3469.0,"discounted_cash":2081.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1439.0,"discounted_cash":863.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":740.0,"discounted_cash":444.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1000.0,"discounted_cash":600.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1000.0,"discounted_cash":600.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":740.0,"discounted_cash":444.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1000.0,"discounted_cash":600.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1000.0,"discounted_cash":600.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":142.0,"discounted_cash":85.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":142.0,"discounted_cash":85.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":337.0,"discounted_cash":202.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":337.0,"discounted_cash":202.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":782.0,"discounted_cash":469.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":635.0,"discounted_cash":381.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5524.0,"discounted_cash":3314.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":217.0,"discounted_cash":130.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":118.0,"discounted_cash":70.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":252.0,"discounted_cash":151.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":252.0,"discounted_cash":151.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":422.0,"discounted_cash":253.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":422.0,"discounted_cash":253.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":568.0,"discounted_cash":340.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":868.0,"discounted_cash":520.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1627.0,"discounted_cash":976.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":615.0,"discounted_cash":369.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12413.0,"discounted_cash":7447.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":285.0,"discounted_cash":171.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":285.0,"discounted_cash":171.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":648.0,"discounted_cash":388.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":123.0,"discounted_cash":73.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":123.0,"discounted_cash":73.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":289.0,"discounted_cash":173.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":289.0,"discounted_cash":173.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":285.0,"discounted_cash":171.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":285.0,"discounted_cash":171.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":648.0,"discounted_cash":388.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":152.0,"discounted_cash":91.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":152.0,"discounted_cash":91.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":360.0,"discounted_cash":216.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":360.0,"discounted_cash":216.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":248.0,"discounted_cash":148.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":248.0,"discounted_cash":148.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":578.0,"discounted_cash":346.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":578.0,"discounted_cash":346.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":417.0,"discounted_cash":250.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":417.0,"discounted_cash":250.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":361.0,"discounted_cash":216.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":361.0,"discounted_cash":216.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":690.0,"discounted_cash":414.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":262.0,"discounted_cash":157.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":262.0,"discounted_cash":157.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":616.0,"discounted_cash":369.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":616.0,"discounted_cash":369.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":568.0,"discounted_cash":340.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":568.0,"discounted_cash":340.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":936.0,"discounted_cash":561.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":568.0,"discounted_cash":340.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":568.0,"discounted_cash":340.8,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":936.0,"discounted_cash":561.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3611.0,"discounted_cash":2166.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":759.0,"discounted_cash":455.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MOLECULAR CYTOGENETICS, HEMMF","code_information":[{"code":"3100529","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":1675.0,"discounted_cash":1005.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":876.0,"discounted_cash":525.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":876.0,"discounted_cash":525.6,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1714.0,"discounted_cash":1028.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8449.0,"discounted_cash":5069.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":97.0,"discounted_cash":58.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":97.0,"discounted_cash":58.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":229.0,"discounted_cash":137.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":264.0,"discounted_cash":158.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":264.0,"discounted_cash":158.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":602.0,"discounted_cash":361.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2594.0,"discounted_cash":1556.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1609.0,"discounted_cash":965.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MOLECULAR CYTOGENETICS, CMAFF","code_information":[{"code":"3100545","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":241.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SO MOLECULAR CYTOGENETICS, CMAFF","code_information":[{"code":"3100546","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.0,"discounted_cash":241.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1810.0,"discounted_cash":1086.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10504.0,"discounted_cash":6302.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1007.0,"discounted_cash":604.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3821.0,"discounted_cash":2292.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3348.0,"discounted_cash":2008.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2413.0,"discounted_cash":1447.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9052.0,"discounted_cash":5431.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6035.0,"discounted_cash":3621.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4219.0,"discounted_cash":2531.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1872.0,"discounted_cash":1123.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2364.0,"discounted_cash":1418.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3744.0,"discounted_cash":2246.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1281.0,"discounted_cash":768.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"POLYGENIC RISK SCORE - POLY","code_information":[{"code":"3100560","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81599","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":178.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ONCOMINE MYELOID PANEL","code_information":[{"code":"3100562","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2699.0,"discounted_cash":1619.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3712.0,"discounted_cash":2227.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2451.0,"discounted_cash":1470.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9560.0,"discounted_cash":5736.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":551.0,"discounted_cash":330.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1108.0,"discounted_cash":664.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 70250 SKULL < 4V","code_information":[{"code":"3200016","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1365.0,"discounted_cash":819.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":566.0,"discounted_cash":339.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":566.0,"discounted_cash":339.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 70355 ORTHOPANTOGRAM","code_information":[{"code":"3200023","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70355","type":"HCPCS"}],"standard_charges":[{"gross_charge":4247.0,"discounted_cash":2548.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 70360 NECK SOFT TISSUE","code_information":[{"code":"3200024","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":373.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1365.0,"discounted_cash":819.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 71120 STERNUM MIN 2V","code_information":[{"code":"3200046","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 72020 SPINE 1V, LUMBAR","code_information":[{"code":"3200049","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":506.0,"discounted_cash":303.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 72020 SPINE 1V, THORACIC","code_information":[{"code":"3200050","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":540.0,"discounted_cash":324.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 72020 SPINE 1V, CERVICAL","code_information":[{"code":"3200051","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":506.0,"discounted_cash":303.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":540.0,"discounted_cash":324.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":688.0,"discounted_cash":412.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":688.0,"discounted_cash":412.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":850.0,"discounted_cash":510.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":934.0,"discounted_cash":560.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":675.0,"discounted_cash":405.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":675.0,"discounted_cash":405.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":776.0,"discounted_cash":465.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":837.0,"discounted_cash":502.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":693.0,"discounted_cash":415.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":693.0,"discounted_cash":415.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":797.0,"discounted_cash":478.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":901.0,"discounted_cash":540.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":693.0,"discounted_cash":415.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":714.0,"discounted_cash":428.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 72265 MYELOGRAPHY LUMBAR","code_information":[{"code":"3200079","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72265","type":"HCPCS"}],"standard_charges":[{"gross_charge":1838.0,"discounted_cash":1102.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 73000 CLAVICAL   COMPLETE-BLT","code_information":[{"code":"3200085","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.0,"discounted_cash":645.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1539.0,"discounted_cash":923.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":772.0,"discounted_cash":463.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":772.0,"discounted_cash":463.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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-LT","code_information":[{"code":"3200092","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2670.0,"discounted_cash":1602.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2670.0,"discounted_cash":1602.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1011.0,"discounted_cash":606.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1099.0,"discounted_cash":659.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":772.0,"discounted_cash":463.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":772.0,"discounted_cash":463.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1010.0,"discounted_cash":606.0,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":772.0,"discounted_cash":463.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":772.0,"discounted_cash":463.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1075.0,"discounted_cash":645.0,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1044.0,"discounted_cash":626.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74220 ESOPHAGUS","code_information":[{"code":"3200188","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":732.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1220.0,"discounted_cash":732.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74250 SMALL INTESTINE","code_information":[{"code":"3200197","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1220.0,"discounted_cash":732.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1220.0,"discounted_cash":732.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1894.0,"discounted_cash":1136.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74300 CHOLANGIO/PANCREAT, INTRAOPERATIVE","code_information":[{"code":"3200203","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.0,"discounted_cash":864.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1611.0,"discounted_cash":966.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1611.0,"discounted_cash":966.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1312.0,"discounted_cash":787.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74450 URETHROCYSTOGRAM, RETROGRADE","code_information":[{"code":"3200223","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74455 URETHROCYSTOGRAM VOIDING","code_information":[{"code":"3200224","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74740 HYSTEROSALPINGOGRAM","code_information":[{"code":"3200228","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":1512.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 75625 AORTOGRAM ABDOMINAL, SERIAL","code_information":[{"code":"3200231","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":8052.0,"discounted_cash":4831.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8976.0,"discounted_cash":5385.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8052.0,"discounted_cash":4831.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":8052.0,"discounted_cash":4831.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":8976.0,"discounted_cash":5385.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 75736 ANGIOGRAM PELVIC SELECTIVE","code_information":[{"code":"3200260","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":8052.0,"discounted_cash":4831.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3266.0,"discounted_cash":1959.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4331.0,"discounted_cash":2598.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2163.0,"discounted_cash":1297.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2163.0,"discounted_cash":1297.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2850.0,"discounted_cash":1710.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6455.0,"discounted_cash":3873.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3266.0,"discounted_cash":1959.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3266.0,"discounted_cash":1959.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3266.0,"discounted_cash":1959.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4520.0,"discounted_cash":2712.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3266.0,"discounted_cash":1959.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1440.0,"discounted_cash":864.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":936.0,"discounted_cash":561.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":623.0,"discounted_cash":373.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1440.0,"discounted_cash":864.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":795.0,"discounted_cash":477.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":795.0,"discounted_cash":477.0,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1044.0,"discounted_cash":626.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1329.0,"discounted_cash":797.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1687.0,"discounted_cash":1012.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1942.0,"discounted_cash":1165.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76496 UNLISTED FLUOROSCOPIC PROCEDURE","code_information":[{"code":"3200333","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76496","type":"HCPCS"}],"standard_charges":[{"gross_charge":936.0,"discounted_cash":561.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1906.0,"discounted_cash":1143.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1906.0,"discounted_cash":1143.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1906.0,"discounted_cash":1143.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1285.0,"discounted_cash":771.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1429.0,"discounted_cash":857.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 77073 BONE LENGTH, STUDIES","code_information":[{"code":"3200349","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.0,"discounted_cash":430.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 77075 OSSEOUS SURVEY, COMPLETE","code_information":[{"code":"3200351","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":1309.0,"discounted_cash":785.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 77076 OSSEOUS SURVEY, INFANT","code_information":[{"code":"3200352","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":411.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":683.0,"discounted_cash":409.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1529.0,"discounted_cash":917.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 70140 FACIAL BONES < 3V","code_information":[{"code":"3200368","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":772.0,"discounted_cash":463.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":711.0,"discounted_cash":426.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":694.0,"discounted_cash":416.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 77085 DXA, BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL, INC VERTEBRAL FX ASSESSMENT","code_information":[{"code":"3200434","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.0,"discounted_cash":368.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":434.0,"discounted_cash":260.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":557.0,"discounted_cash":334.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":642.0,"discounted_cash":385.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":330.0,"discounted_cash":198.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":685.0,"discounted_cash":411.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":685.0,"discounted_cash":411.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":837.0,"discounted_cash":502.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":837.0,"discounted_cash":502.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":913.0,"discounted_cash":547.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":913.0,"discounted_cash":547.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":972.0,"discounted_cash":583.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":891.0,"discounted_cash":534.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1026.0,"discounted_cash":615.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":571.0,"discounted_cash":342.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":571.0,"discounted_cash":342.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":799.0,"discounted_cash":479.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":799.0,"discounted_cash":479.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":860.0,"discounted_cash":516.0,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":394.0,"discounted_cash":236.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 71046 CHEST 2 VIEWS","code_information":[{"code":"3200465","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":279.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 71047 CHEST 3 VIEWS","code_information":[{"code":"3200466","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.0,"discounted_cash":332.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":626.0,"discounted_cash":375.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74018 ABDOMEN SINGLE VIEW","code_information":[{"code":"3200468","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.0,"discounted_cash":277.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 74019 ABDOMEN 2 VIEWS","code_information":[{"code":"3200469","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.0,"discounted_cash":337.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":649.0,"discounted_cash":389.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":394.0,"discounted_cash":236.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":556.0,"discounted_cash":333.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":626.0,"discounted_cash":375.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4291.0,"discounted_cash":2574.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2147.0,"discounted_cash":1288.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6501.0,"discounted_cash":3900.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":6501.0,"discounted_cash":3900.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":520.0,"discounted_cash":312.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":520.0,"discounted_cash":312.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":781.0,"discounted_cash":468.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":520.0,"discounted_cash":312.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":520.0,"discounted_cash":312.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":781.0,"discounted_cash":468.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1445.0,"discounted_cash":867.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1445.0,"discounted_cash":867.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":780.0,"discounted_cash":468.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1832.0,"discounted_cash":1099.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2055.0,"discounted_cash":1233.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":25518.0,"discounted_cash":15310.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12091.0,"discounted_cash":7254.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC PLC BREAST CATH AFTER PARTIAL MASTECTOMY BRACHY","code_information":[{"code":"3330003","type":"CDM"},{"code":"0333","type":"RC"},{"code":"19298","type":"HCPCS"}],"standard_charges":[{"gross_charge":17223.0,"discounted_cash":10333.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1509.0,"discounted_cash":905.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2363.0,"discounted_cash":1417.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3513.0,"discounted_cash":2107.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8674.0,"discounted_cash":5204.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1038.0,"discounted_cash":622.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 77301 IMRT TREATMENT PLANNING","code_information":[{"code":"3330009","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":9853.0,"discounted_cash":5911.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1930.0,"discounted_cash":1158.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":894.0,"discounted_cash":536.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":774.0,"discounted_cash":464.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1224.0,"discounted_cash":734.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2759.0,"discounted_cash":1655.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1380.0,"discounted_cash":828.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1545.0,"discounted_cash":927.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":61400.0,"discounted_cash":36840.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":29560.0,"discounted_cash":17736.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":15350.0,"discounted_cash":9210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":19950.0,"discounted_cash":11970.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":553.0,"discounted_cash":331.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3912.0,"discounted_cash":2347.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1577.0,"discounted_cash":946.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2350.0,"discounted_cash":1410.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3513.0,"discounted_cash":2107.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5053.0,"discounted_cash":3031.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":706.0,"discounted_cash":423.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":237.0,"discounted_cash":142.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":243.0,"discounted_cash":145.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":584.0,"discounted_cash":350.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":618.0,"discounted_cash":370.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1654.0,"discounted_cash":992.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":123.0,"discounted_cash":73.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":321.0,"discounted_cash":192.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2574.0,"discounted_cash":1544.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":756.0,"discounted_cash":453.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1744.0,"discounted_cash":1046.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1460.0,"discounted_cash":876.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2286.0,"discounted_cash":1371.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1460.0,"discounted_cash":876.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1774.0,"discounted_cash":1064.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2353.0,"discounted_cash":1411.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1080.0,"discounted_cash":648.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4082.0,"discounted_cash":2449.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5097.0,"discounted_cash":3058.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":830.0,"discounted_cash":498.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 77778 INTERSTITIAL RAD SOURCE COMPL + SUPERV-FAC","code_information":[{"code":"3330107","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77778","type":"HCPCS"}],"standard_charges":[{"gross_charge":5122.0,"discounted_cash":3073.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3972.0,"discounted_cash":2383.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4566.0,"discounted_cash":2739.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC HDR INTRSTL/INTRCVTY + BASIC DOSMTRY >12 CHNL","code_information":[{"code":"3330110","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77772","type":"HCPCS"}],"standard_charges":[{"gross_charge":5253.0,"discounted_cash":3151.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC APPLY SURFACE LDR RADIONUCLIDE","code_information":[{"code":"3330111","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77789","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.0,"discounted_cash":212.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1070.0,"discounted_cash":642.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":794.0,"discounted_cash":476.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 77435 STEREOTACTIC BODY RADIATION MANAGEMENT, LESION(S), + IMAG,<=5","code_information":[{"code":"3330121","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77435","type":"HCPCS"}],"standard_charges":[{"gross_charge":15350.0,"discounted_cash":9210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3174.0,"discounted_cash":1904.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NM PARATHYROID IMAGING","code_information":[{"code":"3400009","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":2327.0,"discounted_cash":1396.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2620.0,"discounted_cash":1572.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NM LYPHATIC/NODES IMAGING","code_information":[{"code":"3400012","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.0,"discounted_cash":339.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3735.0,"discounted_cash":2241.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3119.0,"discounted_cash":1871.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NM INTESTINE IMAGING (MECKELS)","code_information":[{"code":"3400024","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":4820.0,"discounted_cash":2892.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3352.0,"discounted_cash":2011.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3284.0,"discounted_cash":1970.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2925.0,"discounted_cash":1755.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3352.0,"discounted_cash":2011.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NM MUGA, MULTIPLE STUDIES","code_information":[{"code":"3400038","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78473","type":"HCPCS"}],"standard_charges":[{"gross_charge":4263.0,"discounted_cash":2557.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NM PULMONARY PERFUSION, PARTICULATE","code_information":[{"code":"3400041","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":2534.0,"discounted_cash":1520.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2929.0,"discounted_cash":1757.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3014.0,"discounted_cash":1808.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NM URETERAL REFLUX STUDY","code_information":[{"code":"3400062","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78740","type":"HCPCS"}],"standard_charges":[{"gross_charge":2929.0,"discounted_cash":1757.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC NM INJ PRCD FOR RP BY NON-IMAGE PROBE IV","code_information":[{"code":"3400073","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":613.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6090.0,"discounted_cash":3654.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6742.0,"discounted_cash":4045.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2525.0,"discounted_cash":1515.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3259.0,"discounted_cash":1955.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3797.0,"discounted_cash":2278.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2481.0,"discounted_cash":1488.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2835.0,"discounted_cash":1701.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":877.0,"discounted_cash":526.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1275.0,"discounted_cash":765.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2280.0,"discounted_cash":1368.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2998.0,"discounted_cash":1798.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5995.0,"discounted_cash":3597.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2998.0,"discounted_cash":1798.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3485.0,"discounted_cash":2091.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5230.0,"discounted_cash":3138.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6971.0,"discounted_cash":4182.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4251.0,"discounted_cash":2550.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4251.0,"discounted_cash":2550.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4180.0,"discounted_cash":2508.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4180.0,"discounted_cash":2508.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4539.0,"discounted_cash":2723.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4539.0,"discounted_cash":2723.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4131.0,"discounted_cash":2478.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4131.0,"discounted_cash":2478.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4500.0,"discounted_cash":2700.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4500.0,"discounted_cash":2700.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4344.0,"discounted_cash":2606.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4344.0,"discounted_cash":2606.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4351.0,"discounted_cash":2610.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4351.0,"discounted_cash":2610.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4642.0,"discounted_cash":2785.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4642.0,"discounted_cash":2785.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4079.0,"discounted_cash":2447.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4079.0,"discounted_cash":2447.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4244.0,"discounted_cash":2546.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4244.0,"discounted_cash":2546.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6118.0,"discounted_cash":3670.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6118.0,"discounted_cash":3670.8,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4116.0,"discounted_cash":2469.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4116.0,"discounted_cash":2469.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4116.0,"discounted_cash":2469.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4116.0,"discounted_cash":2469.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6118.0,"discounted_cash":3670.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6118.0,"discounted_cash":3670.8,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6118.0,"discounted_cash":3670.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6118.0,"discounted_cash":3670.8,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6118.0,"discounted_cash":3670.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6118.0,"discounted_cash":3670.8,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6118.0,"discounted_cash":3670.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6118.0,"discounted_cash":3670.8,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6227.0,"discounted_cash":3736.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6227.0,"discounted_cash":3736.2,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6118.0,"discounted_cash":3670.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6118.0,"discounted_cash":3670.8,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4346.0,"discounted_cash":2607.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4346.0,"discounted_cash":2607.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4346.0,"discounted_cash":2607.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4346.0,"discounted_cash":2607.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6520.0,"discounted_cash":3912.0,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6520.0,"discounted_cash":3912.0,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4329.0,"discounted_cash":2597.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4329.0,"discounted_cash":2597.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4418.0,"discounted_cash":2650.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4418.0,"discounted_cash":2650.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4835.0,"discounted_cash":2901.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4835.0,"discounted_cash":2901.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4326.0,"discounted_cash":2595.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4326.0,"discounted_cash":2595.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC 76497 CT UNLISTED PROCEDURE","code_information":[{"code":"3500079","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76497","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4170.0,"discounted_cash":2502.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4170.0,"discounted_cash":2502.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5512.0,"discounted_cash":3307.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":5512.0,"discounted_cash":3307.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":5890.0,"discounted_cash":3534.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":5890.0,"discounted_cash":3534.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":7072.0,"discounted_cash":4243.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":7072.0,"discounted_cash":4243.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6016.0,"discounted_cash":3609.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6016.0,"discounted_cash":3609.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":4078.0,"discounted_cash":2446.8,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6118.0,"discounted_cash":3670.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":6118.0,"discounted_cash":3670.8,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":4997.0,"discounted_cash":2998.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4997.0,"discounted_cash":2998.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":4078.0,"discounted_cash":2446.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":4078.0,"discounted_cash":2446.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3938.0,"discounted_cash":2362.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3938.0,"discounted_cash":2362.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3938.0,"discounted_cash":2362.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4448.0,"discounted_cash":2668.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5215.0,"discounted_cash":3129.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10889.0,"discounted_cash":6533.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12881.0,"discounted_cash":7728.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":16862.0,"discounted_cash":10117.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":17186.0,"discounted_cash":10311.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2262.0,"discounted_cash":1357.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2824.0,"discounted_cash":1694.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3621.0,"discounted_cash":2172.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4238.0,"discounted_cash":2542.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4830.0,"discounted_cash":2898.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4738.0,"discounted_cash":2842.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3749.0,"discounted_cash":2249.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1778.0,"discounted_cash":1066.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1364.0,"discounted_cash":818.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4414.0,"discounted_cash":2648.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1778.0,"discounted_cash":1066.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1336.0,"discounted_cash":801.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1336.0,"discounted_cash":801.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1828.0,"discounted_cash":1096.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1364.0,"discounted_cash":818.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1364.0,"discounted_cash":818.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2683.0,"discounted_cash":1609.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":532.0,"discounted_cash":319.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":532.0,"discounted_cash":319.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1038.0,"discounted_cash":622.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":4146.0,"discounted_cash":2487.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4300.0,"discounted_cash":2580.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6382.0,"discounted_cash":3829.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":379.0,"discounted_cash":227.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 20552 INJ SGL OR MULTI TRIGGER 1 OR 2 MUSCLE","code_information":[{"code":"3610110","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":2502.0,"discounted_cash":1501.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9943.0,"discounted_cash":5965.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1768.0,"discounted_cash":1060.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1768.0,"discounted_cash":1060.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"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":747.0,"discounted_cash":448.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3946.0,"discounted_cash":2367.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3343.0,"discounted_cash":2005.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3343.0,"discounted_cash":2005.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":12245.0,"discounted_cash":7347.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12245.0,"discounted_cash":7347.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12486.0,"discounted_cash":7491.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9677.0,"discounted_cash":5806.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9677.0,"discounted_cash":5806.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":9677.0,"discounted_cash":5806.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":38027.0,"discounted_cash":22816.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 34812 OPEN FEM ART-ENDOVAS PROSTHESIS-GROIN-UNILAT","code_information":[{"code":"3610227","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34812","type":"HCPCS"}],"standard_charges":[{"gross_charge":3771.0,"discounted_cash":2262.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":689.0,"discounted_cash":413.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":1671.0,"discounted_cash":1002.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 36200 INTRO  CATH AORTA","code_information":[{"code":"3610311","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2027.0,"discounted_cash":1216.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC INTRO  CATH AORTA-LT","code_information":[{"code":"3610312","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2027.0,"discounted_cash":1216.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC INTRO  CATH AORTA-RT","code_information":[{"code":"3610313","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":2027.0,"discounted_cash":1216.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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-LT","code_information":[{"code":"3610314","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36215","type":"HCPCS"}],"standard_charges":[{"gross_charge":2027.0,"discounted_cash":1216.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2027.0,"discounted_cash":1216.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 PLC ARTERY INITL 2ND ORD-LT","code_information":[{"code":"3610317","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36216","type":"HCPCS"}],"standard_charges":[{"gross_charge":1982.0,"discounted_cash":1189.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1982.0,"discounted_cash":1189.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"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":1982.0,"discounted_cash":1189.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2027.0,"discounted_cash":1216.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2027.0,"discounted_cash":1216.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 PLC ART INITIL 2ND ORD-LT","code_information":[{"code":"3610328","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1672.0,"discounted_cash":1003.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1672.0,"discounted_cash":1003.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 PLC ART INITIL 3RD ORD-LT","code_information":[{"code":"3610332","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1982.0,"discounted_cash":1189.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1982.0,"discounted_cash":1189.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"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":3532.0,"discounted_cash":2119.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3773.0,"discounted_cash":2263.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1764.0,"discounted_cash":1058.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7879.0,"discounted_cash":4727.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 36569 PICC LINE INSERTION W/O SUBQ PORT >5YRS W/O IMAGING GUIDE","code_information":[{"code":"3610361","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":8089.0,"discounted_cash":4853.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 36569 PICC LINE INSERTION W/O SUBQ PORT >5YRS W/O IMAGING GUIDE","code_information":[{"code":"3610362","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":4216.0,"discounted_cash":2529.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":15378.0,"discounted_cash":9226.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2465.0,"discounted_cash":1479.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1764.0,"discounted_cash":1058.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1723.0,"discounted_cash":1033.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":690.0,"discounted_cash":414.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1506.0,"discounted_cash":903.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12585.0,"discounted_cash":7551.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 37200 TRANSCATHETER BIOPSY","code_information":[{"code":"3610397","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37200","type":"HCPCS"}],"standard_charges":[{"gross_charge":6094.0,"discounted_cash":3656.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2523.0,"discounted_cash":1513.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2575.0,"discounted_cash":1545.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3418.0,"discounted_cash":2050.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3418.0,"discounted_cash":2050.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":5127.0,"discounted_cash":3076.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2461.0,"discounted_cash":1476.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2461.0,"discounted_cash":1476.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2461.0,"discounted_cash":1476.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":5660.0,"discounted_cash":3396.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":836.0,"discounted_cash":501.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3661.0,"discounted_cash":2196.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BIOPSY LIVER-WITH OTHER MAJOR PROC","code_information":[{"code":"3610449","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47001","type":"HCPCS"}],"standard_charges":[{"gross_charge":3127.0,"discounted_cash":1876.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 47490 PERC CHOLECYSTOSTOMY","code_information":[{"code":"3610456","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":4199.0,"discounted_cash":2519.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3743.0,"discounted_cash":2245.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3730.0,"discounted_cash":2238.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7746.0,"discounted_cash":4647.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 49442 PERC INSERT CECOSTOMY TUBE, W/FLURO/CONTRST","code_information":[{"code":"3610493","type":"CDM"},{"code":"0320","type":"RC"},{"code":"49442","type":"HCPCS"}],"standard_charges":[{"gross_charge":15377.0,"discounted_cash":9226.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3255.0,"discounted_cash":1953.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3800.0,"discounted_cash":2280.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1961.0,"discounted_cash":1176.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3815.0,"discounted_cash":2289.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3815.0,"discounted_cash":2289.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"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":5962.0,"discounted_cash":3577.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":5962.0,"discounted_cash":3577.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"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":1768.0,"discounted_cash":1060.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BX CERVIX-SINGLE/MULTIPLE","code_information":[{"code":"3610576","type":"CDM"},{"code":"0361","type":"RC"},{"code":"57500","type":"HCPCS"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":710.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ENDOMETRIAL BIOPSY","code_information":[{"code":"3610580","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58100","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.0,"discounted_cash":236.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":354.0,"discounted_cash":212.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC AMNIOCENTESIS DIAG - (RAD)","code_information":[{"code":"3610586","type":"CDM"},{"code":"0361","type":"RC"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":524.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1186.0,"discounted_cash":711.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5505.0,"discounted_cash":3303.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":20365.0,"discounted_cash":12219.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":12585.0,"discounted_cash":7551.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 62270 LUMBAR PUNCTURE, DIAGNOSTIC","code_information":[{"code":"3610610","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.0,"discounted_cash":1832.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3830.0,"discounted_cash":2298.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1496.0,"discounted_cash":897.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64420 INJ ANES INTERCOSTAL NERVE SGL","code_information":[{"code":"3610619","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1726.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64421 INJ,ANESTH INTERCOSTAL NRVE, EA ADDTL LVL","code_information":[{"code":"3610620","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1726.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC INJ ANESTH AGENT,STELLATE GNGLN(CERIVCAL SYMP)","code_information":[{"code":"3610637","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":4297.0,"discounted_cash":2578.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64520 INJ ANESTH AGENT,LUM/THOR(PARAVRTBL SYM)","code_information":[{"code":"3610638","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1726.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CARDIOVERSION ELECTIVE, EXTERNAL","code_information":[{"code":"3610648","type":"CDM"},{"code":"0361","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.0,"discounted_cash":1465.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC G0269 PLACEMENT OF OCCLUSIVE DEV ART/VEIN","code_information":[{"code":"3610655","type":"CDM"},{"code":"0323","type":"RC"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"gross_charge":1323.0,"discounted_cash":793.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8923.0,"discounted_cash":5353.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":690.0,"discounted_cash":414.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":20365.0,"discounted_cash":12219.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7336.0,"discounted_cash":4401.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":22137.0,"discounted_cash":13282.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8058.0,"discounted_cash":4834.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8982.0,"discounted_cash":5389.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10179.0,"discounted_cash":6107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10179.0,"discounted_cash":6107.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":26781.0,"discounted_cash":16068.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3052.0,"discounted_cash":1831.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2906.0,"discounted_cash":1743.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 49084 PERITONEAL LAVAGE INCL IMAG GUID","code_information":[{"code":"3610924","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":3342.0,"discounted_cash":2005.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":27351.0,"discounted_cash":16410.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1015.0,"discounted_cash":609.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2579.0,"discounted_cash":1547.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2579.0,"discounted_cash":1547.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3360.0,"discounted_cash":2016.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3360.0,"discounted_cash":2016.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":6130.0,"discounted_cash":3678.0,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3573.0,"discounted_cash":2143.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3573.0,"discounted_cash":2143.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3573.0,"discounted_cash":2143.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3007.0,"discounted_cash":1804.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3007.0,"discounted_cash":1804.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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-RT","code_information":[{"code":"3611030","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":4705.0,"discounted_cash":2823.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4705.0,"discounted_cash":2823.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":7057.0,"discounted_cash":4234.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2702.0,"discounted_cash":1621.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2702.0,"discounted_cash":1621.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4061.0,"discounted_cash":2436.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":12585.0,"discounted_cash":7551.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4609.0,"discounted_cash":2765.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4609.0,"discounted_cash":2765.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":7057.0,"discounted_cash":4234.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2702.0,"discounted_cash":1621.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2702.0,"discounted_cash":1621.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4061.0,"discounted_cash":2436.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2829.0,"discounted_cash":1697.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2829.0,"discounted_cash":1697.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4241.0,"discounted_cash":2544.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2829.0,"discounted_cash":1697.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2829.0,"discounted_cash":1697.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4241.0,"discounted_cash":2544.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC INCISION LINGUAL FRENUM (FRENOTOMY)","code_information":[{"code":"3611138","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2502.0,"discounted_cash":1501.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4558.0,"discounted_cash":2734.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4042.0,"discounted_cash":2425.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ARTHOCENTESIS, ASPIRATION AND/OR INJ, SM JOINT OR BURSA; W US, REC/REPORT -RT","code_information":[{"code":"3611156","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":2993.0,"discounted_cash":1795.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 AND/OR INJ, SM JOINT OR BURSA; W US, REC/REPORT -LT","code_information":[{"code":"3611157","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":2993.0,"discounted_cash":1795.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 AND/OR INJ, SM JOINT OR BURSA; W US, REC/REPORT -BLT","code_information":[{"code":"3611158","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":3579.0,"discounted_cash":2147.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC ARTHOCENTESIS, ASPIRATION AND/OR INJ, INT JOINT/BURSA; W US, REC/REPORT -RT","code_information":[{"code":"3611159","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2993.0,"discounted_cash":1795.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 AND/OR INJ, INT JOINT/BURSA; W US, REC/REPORT -LT","code_information":[{"code":"3611160","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":2993.0,"discounted_cash":1795.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 AND/OR INJ, INT JOINT/BURSA; W US, REC/REPORT -BLT","code_information":[{"code":"3611161","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20606","type":"HCPCS"}],"standard_charges":[{"gross_charge":3579.0,"discounted_cash":2147.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":2993.0,"discounted_cash":1795.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2993.0,"discounted_cash":1795.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3579.0,"discounted_cash":2147.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":2878.0,"discounted_cash":1726.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2878.0,"discounted_cash":1726.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2502.0,"discounted_cash":1501.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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; WO US GUIDE-RT","code_information":[{"code":"3611176","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":2502.0,"discounted_cash":1501.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3751.0,"discounted_cash":2250.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":1693.0,"discounted_cash":1015.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":18610.0,"discounted_cash":11166.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6095.0,"discounted_cash":3657.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4200.0,"discounted_cash":2520.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4200.0,"discounted_cash":2520.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4199.0,"discounted_cash":2519.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1490.0,"discounted_cash":894.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1490.0,"discounted_cash":894.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 NEPHROURETER CATH VIA NEW ACC LT","code_information":[{"code":"3611231","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":3801.0,"discounted_cash":2280.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 LT","code_information":[{"code":"3611234","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1320.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2200.0,"discounted_cash":1320.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 LT","code_information":[{"code":"3611237","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":6857.0,"discounted_cash":4114.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":6857.0,"discounted_cash":4114.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"3611336","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1487.0,"discounted_cash":892.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64405 INJ ANES GREATER OCCIPITAL NERVE - LT","code_information":[{"code":"3611337","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":1487.0,"discounted_cash":892.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2474.0,"discounted_cash":1484.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":21923.0,"discounted_cash":13153.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":21923.0,"discounted_cash":13153.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8611.0,"discounted_cash":5166.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":21923.0,"discounted_cash":13153.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":32239.0,"discounted_cash":19343.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":44755.0,"discounted_cash":26853.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10962.0,"discounted_cash":6577.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10962.0,"discounted_cash":6577.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":19573.0,"discounted_cash":11743.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 34712 TRNSCATH DLVR ENHNCD FIX DEV RS&I","code_information":[{"code":"3611364","type":"CDM"},{"code":"0361","type":"RC"},{"code":"34712","type":"HCPCS"}],"standard_charges":[{"gross_charge":19573.0,"discounted_cash":11743.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2473.0,"discounted_cash":1483.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2473.0,"discounted_cash":1483.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2473.0,"discounted_cash":1483.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3064.0,"discounted_cash":1838.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":28185.0,"discounted_cash":16911.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":19573.0,"discounted_cash":11743.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":165.0,"discounted_cash":99.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64486 TRANS ABD PLANE (TAP) BLOCK; UNILAT, INC IMAG-RT","code_information":[{"code":"3611395","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"discounted_cash":1424.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"3611396","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2374.0,"discounted_cash":1424.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"3611397","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64488","type":"HCPCS"}],"standard_charges":[{"gross_charge":3562.0,"discounted_cash":2137.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4221.0,"discounted_cash":2532.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1543.0,"discounted_cash":925.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1543.0,"discounted_cash":925.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":690.0,"discounted_cash":414.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4074.0,"discounted_cash":2444.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2133.0,"discounted_cash":1279.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4163.0,"discounted_cash":2497.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2436.0,"discounted_cash":1461.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1584.0,"discounted_cash":950.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":490.0,"discounted_cash":294.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":540.0,"discounted_cash":324.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":405.0,"discounted_cash":243.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":490.0,"discounted_cash":294.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2373.0,"discounted_cash":1423.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1188.0,"discounted_cash":712.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2018.0,"discounted_cash":1210.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1543.0,"discounted_cash":925.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":771.0,"discounted_cash":462.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1312.0,"discounted_cash":787.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1069.0,"discounted_cash":641.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CRYOPRECIPITATE, EACH UNIT","code_information":[{"code":"3900002","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.0,"discounted_cash":175.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":563.0,"discounted_cash":337.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1582.0,"discounted_cash":949.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC PLATELETS, PHERESIS, EACH UNIT","code_information":[{"code":"3900005","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9034","type":"HCPCS"}],"standard_charges":[{"gross_charge":4318.0,"discounted_cash":2590.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5222.0,"discounted_cash":3133.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1988.0,"discounted_cash":1192.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":594.0,"discounted_cash":356.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5222.0,"discounted_cash":3133.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1713.0,"discounted_cash":1027.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":563.0,"discounted_cash":337.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BLOOD, SPLIT UNIT","code_information":[{"code":"3900012","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9011","type":"HCPCS"}],"standard_charges":[{"gross_charge":581.0,"discounted_cash":348.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1452.0,"discounted_cash":871.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1268.0,"discounted_cash":760.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5441.0,"discounted_cash":3264.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5003.0,"discounted_cash":3001.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1387.0,"discounted_cash":832.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1725.0,"discounted_cash":1035.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1500.0,"discounted_cash":900.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5586.0,"discounted_cash":3351.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2419.0,"discounted_cash":1451.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1069.0,"discounted_cash":641.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1069.0,"discounted_cash":641.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":274.0,"discounted_cash":164.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":274.0,"discounted_cash":164.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1582.0,"discounted_cash":949.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1582.0,"discounted_cash":949.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1988.0,"discounted_cash":1192.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1452.0,"discounted_cash":871.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":961.0,"discounted_cash":576.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1268.0,"discounted_cash":760.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5003.0,"discounted_cash":3001.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1725.0,"discounted_cash":1035.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1500.0,"discounted_cash":900.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5586.0,"discounted_cash":3351.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC CRYOPRECIPITATE, EACH UNIT (5)","code_information":[{"code":"3900056","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1378.0,"discounted_cash":826.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5003.0,"discounted_cash":3001.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":165.0,"discounted_cash":99.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":165.0,"discounted_cash":99.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":247.0,"discounted_cash":148.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC SCREENING  DIGITAL BREAST TOMOSYNTHESIS","code_information":[{"code":"4010025","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.0,"discounted_cash":85.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":676.0,"discounted_cash":405.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":676.0,"discounted_cash":405.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":856.0,"discounted_cash":513.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":856.0,"discounted_cash":513.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":811.0,"discounted_cash":486.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1043.0,"discounted_cash":625.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":689.0,"discounted_cash":413.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":459.0,"discounted_cash":275.4,"setting":"inpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":459.0,"discounted_cash":275.4,"setting":"inpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":689.0,"discounted_cash":413.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":459.0,"discounted_cash":275.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":459.0,"discounted_cash":275.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1582.0,"discounted_cash":949.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2254.0,"discounted_cash":1352.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":963.0,"discounted_cash":577.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":681.0,"discounted_cash":408.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":652.0,"discounted_cash":391.2,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2890.0,"discounted_cash":1734.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76506 US ENCEPHALOGRAPY","code_information":[{"code":"4020018","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76700 US ABDOMEN COMPLETE","code_information":[{"code":"4020024","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76770 US RETROPERITONEAL COMPLETE","code_information":[{"code":"4020028","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76775 US RETROPERITONEAL LIMITED","code_information":[{"code":"4020029","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76776 US TRANSPLANTED,KIDNEY","code_information":[{"code":"4020030","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1579.0,"discounted_cash":947.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":604.0,"discounted_cash":362.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":659.0,"discounted_cash":395.4,"setting":"inpatient","modifier_code":["59"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":814.0,"discounted_cash":488.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76830 US TRANSVAGINAL","code_information":[{"code":"4020045","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1302.0,"discounted_cash":781.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76942 US  GUIDANCE","code_information":[{"code":"4020062","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.0,"discounted_cash":652.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 76998 US GUIDANCE  INTRAOPERATIVE","code_information":[{"code":"4020068","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1597.0,"discounted_cash":958.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1420.0,"discounted_cash":852.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":426.0,"discounted_cash":255.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2008.0,"discounted_cash":1204.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1242.0,"discounted_cash":745.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1242.0,"discounted_cash":745.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":5260.0,"discounted_cash":3156.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":5260.0,"discounted_cash":3156.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":4599.0,"discounted_cash":2759.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1622.0,"discounted_cash":973.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":958.0,"discounted_cash":574.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":958.0,"discounted_cash":574.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1007.0,"discounted_cash":604.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3731.0,"discounted_cash":2238.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2147.0,"discounted_cash":1288.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2609.0,"discounted_cash":1565.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1737.0,"discounted_cash":1042.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC PET BRAIN IMAGING METABOLIC","code_information":[{"code":"4040002","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78608","type":"HCPCS"}],"standard_charges":[{"gross_charge":12162.0,"discounted_cash":7297.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":11131.0,"discounted_cash":6678.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":20341.0,"discounted_cash":12204.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":15954.0,"discounted_cash":9572.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":14807.0,"discounted_cash":8884.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":11612.0,"discounted_cash":6967.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC PET CT-WHOLE BODY","code_information":[{"code":"4040006","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":16379.0,"discounted_cash":9827.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":12846.0,"discounted_cash":7707.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC  31720  CATHETER ASPIRATION, NASOTRACHEAL","code_information":[{"code":"4100001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"31720","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":184.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1573.0,"discounted_cash":943.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1275.0,"discounted_cash":765.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":784.0,"discounted_cash":470.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1454.0,"discounted_cash":872.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 94070 BRONCHIAL CHALLENGE","code_information":[{"code":"4100011","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1288.0,"discounted_cash":772.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 94150 VITAL CAPACITY, TOTAL","code_information":[{"code":"4100012","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.0,"discounted_cash":98.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC  94640  MDI TREATMENT INITIAL","code_information":[{"code":"4100022","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":170.0,"discounted_cash":102.0,"setting":"inpatient","modifier_code":["76"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC  94642  AEROSAL INHAL PENTAMIDINE","code_information":[{"code":"4100025","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":371.0,"discounted_cash":222.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":233.0,"discounted_cash":139.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":97.0,"discounted_cash":58.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":952.0,"discounted_cash":571.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":170.0,"discounted_cash":102.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":282.0,"discounted_cash":169.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1184.0,"discounted_cash":710.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":137.0,"discounted_cash":82.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":155.0,"discounted_cash":93.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":92.0,"discounted_cash":55.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":110.0,"discounted_cash":66.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC  94060  RT-FULL PULMONARY FUNCTION TEST","code_information":[{"code":"4100056","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":689.0,"discounted_cash":413.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"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":192.0,"discounted_cash":115.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC PEDS HOME APNEA MONTIORING EVENT RECORDING","code_information":[{"code":"4100073","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94776","type":"HCPCS"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":319.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 94618 PULMONARY STRESS TESTING","code_information":[{"code":"4100078","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":367.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":613.0,"discounted_cash":367.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":449.0,"discounted_cash":269.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":568.0,"discounted_cash":340.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":568.0,"discounted_cash":340.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"HC 97018 PT PARAFFIN BATH","code_information":[{"code":"4200022","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":52.8,"setting":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":108.0,"discounted_cash":64.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":81.0,"discounted_cash":48.6,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":366.0,"discounted_cash":219.6,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":628.0,"discounted_cash":376.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":386.0,"discounted_cash":231.6,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":412.0,"discounted_cash":247.2,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":464.0,"discounted_cash":278.4,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"},{"gross_charge":268.0,"discounted_cash":160.8,"setting":"outpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GP"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":175.0,"discounted_cash":105.0,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":112.0,"discounted_cash":67.2,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":114.0,"discounted_cash":68.4,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["RT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":"inpatient","modifier_code":["LT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":"inpatient","modifier_code":["RT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":"inpatient","modifier_code":["LT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":"inpatient","modifier_code":["RT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":"inpatient","modifier_code":["LT","GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":386.0,"discounted_cash":231.6,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":412.0,"discounted_cash":247.2,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":464.0,"discounted_cash":278.4,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"},{"gross_charge":268.0,"discounted_cash":160.8,"setting":"outpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO","50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":103.0,"discounted_cash":61.8,"setting":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":71.0,"discounted_cash":42.6,"setting":"inpatient","modifier_code":["GO"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":478.0,"discounted_cash":286.8,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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 92633 SP AUDITORY REHAB POST LINGUAL HEARING","code_information":[{"code":"4400029","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92633","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":138.6,"setting":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":231.0,"discounted_cash":138.6,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["TL"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["TL"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["TL"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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 92626 SP EVAL OF AUDITORY REHAB STATUS-1ST HOUR","code_information":[{"code":"4400049","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92626","type":"HCPCS"}],"standard_charges":[{"gross_charge":467.0,"discounted_cash":280.2,"setting":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":467.0,"discounted_cash":280.2,"setting":"outpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":"inpatient","modifier_code":["GN"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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: SMMCOP | 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":839.0,"discounted_cash":503.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1203.0,"discounted_cash":721.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":943.0,"discounted_cash":565.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8141.0,"discounted_cash":4884.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":645.0,"discounted_cash":387.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10863.0,"discounted_cash":6517.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1160.0,"discounted_cash":696.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":133.0,"discounted_cash":79.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":743.0,"discounted_cash":445.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":504.0,"discounted_cash":302.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2757.0,"discounted_cash":1654.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":637.0,"discounted_cash":382.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1021.0,"discounted_cash":612.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":575.0,"discounted_cash":345.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":656.0,"discounted_cash":393.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":702.0,"discounted_cash":421.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":641.0,"discounted_cash":384.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":858.0,"discounted_cash":514.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":598.0,"discounted_cash":358.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":659.0,"discounted_cash":395.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":929.0,"discounted_cash":557.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":934.0,"discounted_cash":560.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":812.0,"discounted_cash":487.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1009.0,"discounted_cash":605.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1182.0,"discounted_cash":709.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1128.0,"discounted_cash":676.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":934.0,"discounted_cash":560.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1009.0,"discounted_cash":605.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":637.0,"discounted_cash":382.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1365.0,"discounted_cash":819.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":934.0,"discounted_cash":560.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":988.0,"discounted_cash":592.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1009.0,"discounted_cash":605.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1009.0,"discounted_cash":605.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":934.0,"discounted_cash":560.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1182.0,"discounted_cash":709.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1009.0,"discounted_cash":605.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1009.0,"discounted_cash":605.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3094.0,"discounted_cash":1856.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":810.0,"discounted_cash":486.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2810.0,"discounted_cash":1686.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1974.0,"discounted_cash":1184.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":987.0,"discounted_cash":592.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":426.0,"discounted_cash":255.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":743.0,"discounted_cash":445.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1974.0,"discounted_cash":1184.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1158.0,"discounted_cash":694.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":11089.0,"discounted_cash":6653.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":11089.0,"discounted_cash":6653.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2999.0,"discounted_cash":1799.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 21320 CLSD TX NASAL BONE FX  WITH STABILIZATION","code_information":[{"code":"4500107","type":"CDM"},{"code":"0450","type":"RC"},{"code":"21320","type":"HCPCS"}],"standard_charges":[{"gross_charge":6681.0,"discounted_cash":4008.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":616.0,"discounted_cash":369.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":616.0,"discounted_cash":369.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":925.0,"discounted_cash":555.0,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":510.0,"discounted_cash":306.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 RT","code_information":[{"code":"4500127","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23605","type":"HCPCS"}],"standard_charges":[{"gross_charge":5382.0,"discounted_cash":3229.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":5493.0,"discounted_cash":3295.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":498.0,"discounted_cash":298.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":498.0,"discounted_cash":298.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":748.0,"discounted_cash":448.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":990.0,"discounted_cash":594.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":990.0,"discounted_cash":594.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":1680.0,"discounted_cash":1008.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3435.0,"discounted_cash":2061.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3152.0,"discounted_cash":1891.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3152.0,"discounted_cash":1891.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1680.0,"discounted_cash":1008.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2657.0,"discounted_cash":1594.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2626.0,"discounted_cash":1575.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1680.0,"discounted_cash":1008.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":537.0,"discounted_cash":322.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":537.0,"discounted_cash":322.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":510.0,"discounted_cash":306.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":510.0,"discounted_cash":306.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2491.0,"discounted_cash":1494.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2491.0,"discounted_cash":1494.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":784.0,"discounted_cash":470.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":784.0,"discounted_cash":470.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3210.0,"discounted_cash":1926.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3210.0,"discounted_cash":1926.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":839.0,"discounted_cash":503.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4673.0,"discounted_cash":2803.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":16380.0,"discounted_cash":9828.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":16380.0,"discounted_cash":9828.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":10813.0,"discounted_cash":6487.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1075.0,"discounted_cash":645.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1075.0,"discounted_cash":645.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3184.0,"discounted_cash":1910.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3184.0,"discounted_cash":1910.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":518.0,"discounted_cash":310.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":518.0,"discounted_cash":310.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1077.0,"discounted_cash":646.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":998.0,"discounted_cash":598.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1139.0,"discounted_cash":683.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6661.0,"discounted_cash":3996.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1077.0,"discounted_cash":646.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3364.0,"discounted_cash":2018.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3364.0,"discounted_cash":2018.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":874.0,"discounted_cash":524.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":874.0,"discounted_cash":524.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":8076.0,"discounted_cash":4845.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":7912.0,"discounted_cash":4747.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":3669.0,"discounted_cash":2201.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3745.0,"discounted_cash":2247.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2881.0,"discounted_cash":1728.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2881.0,"discounted_cash":1728.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":480.0,"discounted_cash":288.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":480.0,"discounted_cash":288.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3146.0,"discounted_cash":1887.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3146.0,"discounted_cash":1887.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":498.0,"discounted_cash":298.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":498.0,"discounted_cash":298.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1680.0,"discounted_cash":1008.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1680.0,"discounted_cash":1008.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":484.0,"discounted_cash":290.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":484.0,"discounted_cash":290.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":491.0,"discounted_cash":294.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":491.0,"discounted_cash":294.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1479.0,"discounted_cash":887.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 RT","code_information":[{"code":"4500291","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":3441.0,"discounted_cash":2064.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3441.0,"discounted_cash":2064.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":480.0,"discounted_cash":288.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":537.0,"discounted_cash":322.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":537.0,"discounted_cash":322.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":537.0,"discounted_cash":322.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":537.0,"discounted_cash":322.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":508.0,"discounted_cash":304.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1139.0,"discounted_cash":683.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 28540 CLSD TARSAL BONE DISLOC,W/O ANES RT","code_information":[{"code":"4500302","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 28540 CLSD TARSAL BONE DISLOC,W/O ANES LT","code_information":[{"code":"4500303","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":887.0,"discounted_cash":532.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1077.0,"discounted_cash":646.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":688.0,"discounted_cash":412.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1533.0,"discounted_cash":919.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1533.0,"discounted_cash":919.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":529.0,"discounted_cash":317.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":529.0,"discounted_cash":317.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":633.0,"discounted_cash":379.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 29540 STRAPPING, ANKLE RT","code_information":[{"code":"4500338","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":412.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":688.0,"discounted_cash":412.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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, CASTING OR STRAPPING","code_information":[{"code":"4500345","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29799","type":"HCPCS"}],"standard_charges":[{"gross_charge":727.0,"discounted_cash":436.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 30300 REMOVAL FB, INTRANASAL","code_information":[{"code":"4500346","type":"CDM"},{"code":"0450","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":192.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":677.0,"discounted_cash":406.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":574.0,"discounted_cash":344.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":699.0,"discounted_cash":419.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":437.0,"discounted_cash":262.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":998.0,"discounted_cash":598.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":453.0,"discounted_cash":271.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1540.0,"discounted_cash":924.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 31605 TRACHEOSTOMY, CRICOTHYROID MEMBRANE","code_information":[{"code":"4500361","type":"CDM"},{"code":"0450","type":"RC"},{"code":"31605","type":"HCPCS"}],"standard_charges":[{"gross_charge":4424.0,"discounted_cash":2654.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1457.0,"discounted_cash":874.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1726.0,"discounted_cash":1035.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1726.0,"discounted_cash":1035.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1726.0,"discounted_cash":1035.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":20117.0,"discounted_cash":12070.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":159.0,"discounted_cash":95.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 36425 VENIPUNCTURE, CUTDOWN, 1 YR +","code_information":[{"code":"4500383","type":"CDM"},{"code":"0450","type":"RC"},{"code":"36425","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":251.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3267.0,"discounted_cash":1960.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3646.0,"discounted_cash":2187.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3262.0,"discounted_cash":1957.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":415.0,"discounted_cash":249.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":610.0,"discounted_cash":366.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":902.0,"discounted_cash":541.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":992.0,"discounted_cash":595.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":747.0,"discounted_cash":448.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6501.0,"discounted_cash":3900.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1529.0,"discounted_cash":917.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":977.0,"discounted_cash":586.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":503.0,"discounted_cash":301.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":415.0,"discounted_cash":249.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2671.0,"discounted_cash":1602.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2671.0,"discounted_cash":1602.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2671.0,"discounted_cash":1602.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 43761 REPOSITONING GASTRIC FEED TUBE","code_information":[{"code":"4500421","type":"CDM"},{"code":"0450","type":"RC"},{"code":"43761","type":"HCPCS"}],"standard_charges":[{"gross_charge":5017.0,"discounted_cash":3010.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1918.0,"discounted_cash":1150.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":11871.0,"discounted_cash":7122.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1503.0,"discounted_cash":901.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1448.0,"discounted_cash":868.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5515.0,"discounted_cash":3309.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 46600 ANOSCOPY, DIAGNOSTIC","code_information":[{"code":"4500430","type":"CDM"},{"code":"0450","type":"RC"},{"code":"46600","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":117.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1863.0,"discounted_cash":1117.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 51700 BLADDER IRRIGATION-SIMPLE","code_information":[{"code":"4500438","type":"CDM"},{"code":"0450","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.0,"discounted_cash":868.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":577.0,"discounted_cash":346.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":326.0,"discounted_cash":195.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":743.0,"discounted_cash":445.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1592.0,"discounted_cash":955.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":926.0,"discounted_cash":555.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":508.0,"discounted_cash":304.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2925.0,"discounted_cash":1755.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1955.0,"discounted_cash":1173.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":879.0,"discounted_cash":527.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":558.0,"discounted_cash":334.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 59409 VAGINAL DELIVERY ONLY","code_information":[{"code":"4500457","type":"CDM"},{"code":"0450","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":6199.0,"discounted_cash":3719.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 59414 DELIVERY OF PLACENTA","code_information":[{"code":"4500458","type":"CDM"},{"code":"0450","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":3339.0,"discounted_cash":2003.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1177.0,"discounted_cash":706.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3839.0,"discounted_cash":2303.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1221.0,"discounted_cash":732.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":702.0,"discounted_cash":421.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":702.0,"discounted_cash":421.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":702.0,"discounted_cash":421.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":651.0,"discounted_cash":390.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":651.0,"discounted_cash":390.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":664.0,"discounted_cash":398.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":702.0,"discounted_cash":421.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":702.0,"discounted_cash":421.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":1237.0,"discounted_cash":742.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1237.0,"discounted_cash":742.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":906.0,"discounted_cash":543.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":906.0,"discounted_cash":543.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":395.0,"discounted_cash":237.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":395.0,"discounted_cash":237.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":421.0,"discounted_cash":252.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":79.0,"discounted_cash":47.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 92950 CARDIOPULMONARY RESUSCITATION","code_information":[{"code":"4500507","type":"CDM"},{"code":"0450","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":3246.0,"discounted_cash":1947.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":305.0,"discounted_cash":183.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":633.0,"discounted_cash":379.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1080.0,"discounted_cash":648.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1711.0,"discounted_cash":1026.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2844.0,"discounted_cash":1706.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3917.0,"discounted_cash":2350.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":952.0,"discounted_cash":571.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1153.0,"discounted_cash":691.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":310.0,"discounted_cash":186.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1139.0,"discounted_cash":683.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":4327.0,"discounted_cash":2596.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7132.0,"discounted_cash":4279.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":419.0,"discounted_cash":251.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1091.0,"discounted_cash":654.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3211.0,"discounted_cash":1926.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3876.0,"discounted_cash":2325.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":830.0,"discounted_cash":498.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4327.0,"discounted_cash":2596.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2822.0,"discounted_cash":1693.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2841.0,"discounted_cash":1704.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 49084 PERITONEAL LAVAGE INCL IMAG GUID","code_information":[{"code":"4500575","type":"CDM"},{"code":"0450","type":"RC"},{"code":"49084","type":"HCPCS"}],"standard_charges":[{"gross_charge":3267.0,"discounted_cash":1960.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3714.0,"discounted_cash":2228.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 23655 CLSD TX SHLDR DISLOC W MANIP W ANES-LT","code_information":[{"code":"4500578","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":3791.0,"discounted_cash":2274.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 - RT","code_information":[{"code":"4500582","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.0,"discounted_cash":364.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":608.0,"discounted_cash":364.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":682.0,"discounted_cash":409.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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-RT","code_information":[{"code":"4500589","type":"CDM"},{"code":"0450","type":"RC"},{"code":"32554","type":"HCPCS"}],"standard_charges":[{"gross_charge":2522.0,"discounted_cash":1513.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2522.0,"discounted_cash":1513.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1410.0,"discounted_cash":846.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1410.0,"discounted_cash":846.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2113.0,"discounted_cash":1267.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":1637.0,"discounted_cash":982.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1637.0,"discounted_cash":982.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":493.0,"discounted_cash":295.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":682.0,"discounted_cash":409.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":682.0,"discounted_cash":409.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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-LT","code_information":[{"code":"4500616","type":"CDM"},{"code":"0450","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":80.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":343.0,"discounted_cash":205.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1347.0,"discounted_cash":808.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":933.0,"discounted_cash":559.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":933.0,"discounted_cash":559.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 27538 CLSD TX KNEE FX(S) W/WO MANIP RT","code_information":[{"code":"4500655","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":466.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 27538 CLSD TX KNEE FX(S) W/WO MANIP LT","code_information":[{"code":"4500656","type":"CDM"},{"code":"0450","type":"RC"},{"code":"27538","type":"HCPCS"}],"standard_charges":[{"gross_charge":778.0,"discounted_cash":466.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":426.0,"discounted_cash":255.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":426.0,"discounted_cash":255.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":426.0,"discounted_cash":255.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":641.0,"discounted_cash":384.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1494.0,"discounted_cash":896.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1494.0,"discounted_cash":896.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2242.0,"discounted_cash":1345.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1245.0,"discounted_cash":747.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1245.0,"discounted_cash":747.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1976.0,"discounted_cash":1185.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1622.0,"discounted_cash":973.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1622.0,"discounted_cash":973.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 ARTHOCENTESIS, ASPIRATION AND/OR INJ, SM JOINT/BURSA; W US, REC/REPORT -RT","code_information":[{"code":"4500740","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":809.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 20604 ARTHOCENTESIS, ASPIRATION AND/OR INJ, SM JOINT/BURSA; W US, REC/REPORT -LT","code_information":[{"code":"4500741","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1349.0,"discounted_cash":809.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":619.0,"discounted_cash":371.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":619.0,"discounted_cash":371.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":928.0,"discounted_cash":556.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1526.0,"discounted_cash":915.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1526.0,"discounted_cash":915.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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-RT","code_information":[{"code":"4500751","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1327.0,"discounted_cash":796.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1327.0,"discounted_cash":796.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":948.0,"discounted_cash":568.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":790.0,"discounted_cash":474.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":790.0,"discounted_cash":474.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left 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":1447.0,"discounted_cash":868.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":537.0,"discounted_cash":322.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4383.0,"discounted_cash":2629.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4294.0,"discounted_cash":2576.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":312.0,"discounted_cash":187.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":312.0,"discounted_cash":187.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 BLT","code_information":[{"code":"4500774","type":"CDM"},{"code":"0450","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":521.0,"discounted_cash":312.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":467.0,"discounted_cash":280.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":2075.0,"discounted_cash":1245.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2075.0,"discounted_cash":1245.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3114.0,"discounted_cash":1868.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 24605 CLSD TX ELBOW DISLOC W/ ANES-RT","code_information":[{"code":"4500783","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3291.0,"discounted_cash":1974.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 24605 CLSD TX ELBOW DISLOC W/ ANES-LT","code_information":[{"code":"4500784","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3291.0,"discounted_cash":1974.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":3367.0,"discounted_cash":2020.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3367.0,"discounted_cash":2020.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":679.0,"discounted_cash":407.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":958.0,"discounted_cash":574.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1494.0,"discounted_cash":896.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":402.0,"discounted_cash":241.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":410.0,"discounted_cash":246.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3342.0,"discounted_cash":2005.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1237.0,"discounted_cash":742.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1237.0,"discounted_cash":742.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":831.0,"discounted_cash":498.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 61070 VP RESERVOIR TAP ASPIRATION/INJECTION","code_information":[{"code":"4500850","type":"CDM"},{"code":"0450","type":"RC"},{"code":"61070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1782.0,"discounted_cash":1069.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 20950 MONITORING OF INTERSTITIAL FLUID PRESSURE RT","code_information":[{"code":"4500855","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.0,"discounted_cash":921.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 20950 MONITORING OF INTERSTITIAL FLUID PRESSURE LT","code_information":[{"code":"4500856","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.0,"discounted_cash":921.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":1659.0,"discounted_cash":995.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3466.0,"discounted_cash":2079.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3469.0,"discounted_cash":2081.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":419.0,"discounted_cash":251.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10863.0,"discounted_cash":6517.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":773.0,"discounted_cash":463.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 20604 ARTHROCENTESIS ASPIRATION &/OR INJ SM JT/BURSA WITH US GUIDE","code_information":[{"code":"4500867","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20604","type":"HCPCS"}],"standard_charges":[{"gross_charge":1322.0,"discounted_cash":793.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1494.0,"discounted_cash":896.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1301.0,"discounted_cash":780.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":910.0,"discounted_cash":546.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 20950 MONITOR INTERSTITIAL FLUID PRESSURE COMPARTMENT SYNDROME","code_information":[{"code":"4500872","type":"CDM"},{"code":"0450","type":"RC"},{"code":"20950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1505.0,"discounted_cash":903.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":907.0,"discounted_cash":544.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":499.0,"discounted_cash":299.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5382.0,"discounted_cash":3229.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":733.0,"discounted_cash":439.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":971.0,"discounted_cash":582.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 23655 CLSD TX SHOULDER DSLC WITH MANIP WITH ANES","code_information":[{"code":"4500887","type":"CDM"},{"code":"0450","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":3714.0,"discounted_cash":2228.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3364.0,"discounted_cash":2018.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3298.0,"discounted_cash":1978.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3152.0,"discounted_cash":1891.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 24605 CLSD TX ELBOW DISLOCATION WITH ANES","code_information":[{"code":"4500900","type":"CDM"},{"code":"0450","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":3224.0,"discounted_cash":1934.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2604.0,"discounted_cash":1562.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":527.0,"discounted_cash":316.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":499.0,"discounted_cash":299.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2491.0,"discounted_cash":1494.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":768.0,"discounted_cash":460.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3210.0,"discounted_cash":1926.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":16047.0,"discounted_cash":9628.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1054.0,"discounted_cash":632.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3119.0,"discounted_cash":1871.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":508.0,"discounted_cash":304.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3364.0,"discounted_cash":2018.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3145.0,"discounted_cash":1887.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":856.0,"discounted_cash":513.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":7912.0,"discounted_cash":4747.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3669.0,"discounted_cash":2201.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":915.0,"discounted_cash":549.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4294.0,"discounted_cash":2576.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2823.0,"discounted_cash":1693.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":480.0,"discounted_cash":288.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3082.0,"discounted_cash":1849.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":489.0,"discounted_cash":293.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":484.0,"discounted_cash":290.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":480.0,"discounted_cash":288.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3371.0,"discounted_cash":2022.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":527.0,"discounted_cash":316.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":527.0,"discounted_cash":316.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 28540 CLSD TX TARSAL BONE DISLOCATION (NO TALOTARSAL) W/O ANES","code_information":[{"code":"4500976","type":"CDM"},{"code":"0450","type":"RC"},{"code":"28540","type":"HCPCS"}],"standard_charges":[{"gross_charge":1116.0,"discounted_cash":669.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":621.0,"discounted_cash":372.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":621.0,"discounted_cash":372.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1503.0,"discounted_cash":901.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":518.0,"discounted_cash":310.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":621.0,"discounted_cash":372.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":674.0,"discounted_cash":404.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1662.0,"discounted_cash":997.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2471.0,"discounted_cash":1482.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2070.0,"discounted_cash":1242.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":628.0,"discounted_cash":376.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64405 INJ ANES AGENT &/OR STEROID OCCIPITAL NERVE","code_information":[{"code":"4501011","type":"CDM"},{"code":"0450","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.0,"discounted_cash":400.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1494.0,"discounted_cash":896.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1975.0,"discounted_cash":1185.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3050.0,"discounted_cash":1830.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1936.0,"discounted_cash":1161.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":688.0,"discounted_cash":412.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":651.0,"discounted_cash":390.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":667.0,"discounted_cash":400.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1212.0,"discounted_cash":727.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":906.0,"discounted_cash":543.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1589.0,"discounted_cash":953.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":412.0,"discounted_cash":247.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":458.0,"discounted_cash":274.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3218.0,"discounted_cash":1930.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3218.0,"discounted_cash":1930.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3218.0,"discounted_cash":1930.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":13691.0,"discounted_cash":8214.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":608.0,"discounted_cash":364.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3303.0,"discounted_cash":1981.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6487.0,"discounted_cash":3892.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":602.0,"discounted_cash":361.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":312.0,"discounted_cash":187.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":614.0,"discounted_cash":368.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":632.0,"discounted_cash":379.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":27221.0,"discounted_cash":16332.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":38981.0,"discounted_cash":23388.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 92960 CARDIOVERSION ELECTIVE, EXTERNAL","code_information":[{"code":"4800011","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":4344.0,"discounted_cash":2606.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1274.0,"discounted_cash":764.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6321.0,"discounted_cash":3792.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2431.0,"discounted_cash":1458.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1893.0,"discounted_cash":1135.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4170.0,"discounted_cash":2502.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2157.0,"discounted_cash":1294.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1012.0,"discounted_cash":607.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4226.0,"discounted_cash":2535.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ECHO DOPPLER, COMPLETE","code_information":[{"code":"4800116","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1377.0,"discounted_cash":826.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":655.0,"discounted_cash":393.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":924.0,"discounted_cash":554.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2298.0,"discounted_cash":1378.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3018.0,"discounted_cash":1810.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4027.0,"discounted_cash":2416.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2738.0,"discounted_cash":1642.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2629.0,"discounted_cash":1577.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":365.0,"discounted_cash":219.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":20672.0,"discounted_cash":12403.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":18912.0,"discounted_cash":11347.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":20951.0,"discounted_cash":12570.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":22022.0,"discounted_cash":13213.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":24061.0,"discounted_cash":14436.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":831.0,"discounted_cash":498.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1320.0,"discounted_cash":792.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4010.0,"discounted_cash":2406.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4537.0,"discounted_cash":2722.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5442.0,"discounted_cash":3265.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4892.0,"discounted_cash":2935.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3024.0,"discounted_cash":1814.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":25743.0,"discounted_cash":15445.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":25743.0,"discounted_cash":15445.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":25743.0,"discounted_cash":15445.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":226.0,"discounted_cash":135.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":17613.0,"discounted_cash":10567.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":942.0,"discounted_cash":565.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 10061 INC/DRN ABCSS/CYST COMP MULTIPLE","code_information":[{"code":"5100002","type":"CDM"},{"code":"0510","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1152.0,"discounted_cash":691.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1644.0,"discounted_cash":986.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":637.0,"discounted_cash":382.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1392.0,"discounted_cash":835.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1875.0,"discounted_cash":1125.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4316.0,"discounted_cash":2589.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":938.0,"discounted_cash":562.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":307.0,"discounted_cash":184.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":724.0,"discounted_cash":434.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":724.0,"discounted_cash":434.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1083.0,"discounted_cash":649.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":332.0,"discounted_cash":199.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 59000 AMNIOCENTESIS DIAGNOSTIC","code_information":[{"code":"5100044","type":"CDM"},{"code":"0510","type":"RC"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":914.0,"discounted_cash":548.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2340.0,"discounted_cash":1404.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":895.0,"discounted_cash":537.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":895.0,"discounted_cash":537.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":484.0,"discounted_cash":290.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":241.0,"discounted_cash":144.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":342.0,"discounted_cash":205.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":544.0,"discounted_cash":326.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":712.0,"discounted_cash":427.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":138.0,"discounted_cash":82.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":176.0,"discounted_cash":105.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":295.0,"discounted_cash":177.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":445.0,"discounted_cash":267.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":629.0,"discounted_cash":377.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 20550 INJ SNGL TENDON/LIGAMNT APONEUROSIS","code_information":[{"code":"5100180","type":"CDM"},{"code":"0511","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1784.0,"discounted_cash":1070.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3745.0,"discounted_cash":2247.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 63650 PERC IMPLANT NEUROSTIMULATOR ELECTRODE","code_information":[{"code":"5100194","type":"CDM"},{"code":"0511","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":31944.0,"discounted_cash":19166.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 64417 INJ ANES AXILLARY NERVE RT","code_information":[{"code":"5100199","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 64417 INJ ANES AXILLARY NERVE LT","code_information":[{"code":"5100200","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 64418 INJ ANES SUPRASCAPULAR NERVE RT","code_information":[{"code":"5100201","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 64418 INJ ANES SUPRASCAPULAR NERVE LT","code_information":[{"code":"5100202","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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,ANESTH INTERCOSTAL NRVE,SGL","code_information":[{"code":"5100203","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64420 INJ,ANESTH INTERCOSTAL NRVE,SGL-LT","code_information":[{"code":"5100204","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 64479 INJ TRANSFORAMINAL CER/THR SINGLE","code_information":[{"code":"5100219","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 64480 INJ TRANSFORAMINAL CER/THR EA ADD'","code_information":[{"code":"5100220","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3745.0,"discounted_cash":2247.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5784.0,"discounted_cash":3470.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 99202 OP VISIT NEW PTLEVEL II","code_information":[{"code":"5100238","type":"CDM"},{"code":"0511","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":144.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":934.0,"discounted_cash":560.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":653.0,"discounted_cash":391.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1784.0,"discounted_cash":1070.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2314.0,"discounted_cash":1388.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2314.0,"discounted_cash":1388.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":5784.0,"discounted_cash":3470.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 PARAVERT AGNT CERVICAL/THORACIC RT","code_information":[{"code":"5100395","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2457.0,"discounted_cash":1474.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2457.0,"discounted_cash":1474.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":1587.0,"discounted_cash":952.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3596.0,"discounted_cash":2157.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3662.0,"discounted_cash":2197.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3662.0,"discounted_cash":2197.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":4213.0,"discounted_cash":2527.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3157.0,"discounted_cash":1894.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2761.0,"discounted_cash":1656.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3662.0,"discounted_cash":2197.2,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2746.0,"discounted_cash":1647.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2746.0,"discounted_cash":1647.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":8674.0,"discounted_cash":5204.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":3745.0,"discounted_cash":2247.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4438.0,"discounted_cash":2662.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":3151.0,"discounted_cash":1890.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"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":3059.0,"discounted_cash":1835.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":758.0,"discounted_cash":454.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5714.0,"discounted_cash":3428.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1887.0,"discounted_cash":1132.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3059.0,"discounted_cash":1835.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":758.0,"discounted_cash":454.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3518.0,"discounted_cash":2110.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1887.0,"discounted_cash":1132.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4438.0,"discounted_cash":2662.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4438.0,"discounted_cash":2662.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":6649.0,"discounted_cash":3989.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1553.0,"discounted_cash":931.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1553.0,"discounted_cash":931.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2333.0,"discounted_cash":1399.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":5540.0,"discounted_cash":3324.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":5540.0,"discounted_cash":3324.0,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":10719.0,"discounted_cash":6431.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":4241.0,"discounted_cash":2544.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4241.0,"discounted_cash":2544.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":6360.0,"discounted_cash":3816.0,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC","code_information":[{"code":"5100564","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2871.0,"discounted_cash":1722.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 63685 INS/REP SPINAL NEUROSTIM GEN OR RECEIVER","code_information":[{"code":"5100632","type":"CDM"},{"code":"0511","type":"RC"},{"code":"63685","type":"HCPCS"}],"standard_charges":[{"gross_charge":65484.0,"discounted_cash":39290.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":410.0,"discounted_cash":246.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2814.0,"discounted_cash":1688.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3151.0,"discounted_cash":1890.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2447.0,"discounted_cash":1468.2,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":2321.0,"discounted_cash":1392.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":2321.0,"discounted_cash":1392.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3483.0,"discounted_cash":2089.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1644.0,"discounted_cash":986.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5181.0,"discounted_cash":3108.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6740.0,"discounted_cash":4044.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC G0010 ADMINISTRATION OF HEPATITIS B VACCINE","code_information":[{"code":"5100993","type":"CDM"},{"code":"0771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.0,"discounted_cash":48.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":866.0,"discounted_cash":519.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":866.0,"discounted_cash":519.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":802.0,"discounted_cash":481.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 11103 TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"5101169","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11103","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":346.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 11105 PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"5101170","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11105","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":346.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 11107 INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION","code_information":[{"code":"5101171","type":"CDM"},{"code":"0510","type":"RC"},{"code":"11107","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":346.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3123.0,"discounted_cash":1873.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 62328 DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"5101214","type":"CDM"},{"code":"0511","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":3829.0,"discounted_cash":2297.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3048.0,"discounted_cash":1828.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":3048.0,"discounted_cash":1828.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":4573.0,"discounted_cash":2743.8,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"HC 64624 DEST GENICULAR NERVE BRANCHES W/IMG WHEN PERFORMED - LT","code_information":[{"code":"5101226","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":7294.0,"discounted_cash":4376.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"HC 64624 DEST GENICULAR NERVE BRANCHES W/IMG WHEN PERFORMED - RT","code_information":[{"code":"5101227","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":7294.0,"discounted_cash":4376.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"HC 64624 DEST GENICULAR NERVE BRANCHES W/IMG WHEN PERFORMED - BLT","code_information":[{"code":"5101228","type":"CDM"},{"code":"0511","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":10941.0,"discounted_cash":6564.6,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":189.0,"discounted_cash":113.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":266.0,"discounted_cash":159.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1138.0,"discounted_cash":682.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2845.0,"discounted_cash":1707.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MRA HEAD W/ CONTRAST","code_information":[{"code":"6100009","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MRA NECK W/ CONTRAST","code_information":[{"code":"6100012","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70548","type":"HCPCS"}],"standard_charges":[{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":7084.0,"discounted_cash":4250.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":7084.0,"discounted_cash":4250.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6902.0,"discounted_cash":4141.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6902.0,"discounted_cash":4141.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":7411.0,"discounted_cash":4446.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":7411.0,"discounted_cash":4446.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC MRA CHEST W/CONTRAST","code_information":[{"code":"6100024","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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-LT","code_information":[{"code":"6100048","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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 - LT","code_information":[{"code":"6100051","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":6999.0,"discounted_cash":4199.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6999.0,"discounted_cash":4199.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6999.0,"discounted_cash":4199.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6999.0,"discounted_cash":4199.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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-LT","code_information":[{"code":"6100060","type":"CDM"},{"code":"0618","type":"RC"},{"code":"73225","type":"HCPCS"}],"standard_charges":[{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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 - LT","code_information":[{"code":"6100063","type":"CDM"},{"code":"0610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":7004.0,"discounted_cash":4202.4,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":7004.0,"discounted_cash":4202.4,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":7004.0,"discounted_cash":4202.4,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":7004.0,"discounted_cash":4202.4,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","modifier_code":["50"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | 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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":6866.0,"discounted_cash":4119.6,"setting":"outpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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-RT","code_information":[{"code":"6100151","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77048","type":"HCPCS"}],"standard_charges":[{"gross_charge":7350.0,"discounted_cash":4410.0,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified 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":7350.0,"discounted_cash":4410.0,"setting":"outpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP | The modified price is 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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":10299.0,"discounted_cash":6179.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":10299.0,"discounted_cash":6179.4,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":6866.0,"discounted_cash":4119.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":6866.0,"discounted_cash":4119.6,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":63.0,"discounted_cash":37.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":224.0,"discounted_cash":134.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":616.0,"discounted_cash":369.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":234.0,"discounted_cash":140.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":151.0,"discounted_cash":90.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC KINEVAC PER VIAL","code_information":[{"code":"6210001","type":"CDM"},{"code":"0636","type":"RC"},{"code":"J2805","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.0,"discounted_cash":172.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8.0,"discounted_cash":4.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":19.0,"discounted_cash":11.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":10.0,"discounted_cash":6.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":14.0,"discounted_cash":8.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC LOCM 100-199MG/ML, IODINE/ML MYELOGRAM","code_information":[{"code":"6210007","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9965","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":13.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":21.0,"discounted_cash":12.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":62.0,"discounted_cash":37.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC HOCM 250-299MG/ML IODINE, PER ML","code_information":[{"code":"6210016","type":"CDM"},{"code":"0636","type":"RC"},{"code":"Q9961","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":8.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC INJ GADOTERIDOL, PER ML","code_information":[{"code":"6210022","type":"CDM"},{"code":"0636","type":"RC"},{"code":"A9576","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":13.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC RECOVERY, LEVEL 1","code_information":[{"code":"7100001","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100001","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.0,"discounted_cash":1165.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC RECOVERY, LEVEL 2","code_information":[{"code":"7100002","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100002","type":"HCPCS"}],"standard_charges":[{"gross_charge":2901.0,"discounted_cash":1740.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC RECOVERY, LEVEL 3","code_information":[{"code":"7100003","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100003","type":"HCPCS"}],"standard_charges":[{"gross_charge":3295.0,"discounted_cash":1977.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC RECOVERY, LEVEL 4","code_information":[{"code":"7100004","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100004","type":"HCPCS"}],"standard_charges":[{"gross_charge":3796.0,"discounted_cash":2277.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC RECOVERY, LEVEL 5","code_information":[{"code":"7100005","type":"CDM"},{"code":"0710","type":"RC"},{"code":"7100005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4116.0,"discounted_cash":2469.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2211.0,"discounted_cash":1326.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":423.0,"discounted_cash":253.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":355.0,"discounted_cash":213.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":11081.0,"discounted_cash":6648.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC AMNIOCENTESIS DIAGNOSTIC","code_information":[{"code":"7200002","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":1044.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC FETAL NON-STRESS TEST","code_information":[{"code":"7200004","type":"CDM"},{"code":"0920","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":1345.0,"discounted_cash":807.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3911.0,"discounted_cash":2346.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BILIRUBIN,TOTAL,TRANCUTANEOUS","code_information":[{"code":"7200007","type":"CDM"},{"code":"0300","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":77.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":117.0,"discounted_cash":70.2,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"description":"HC BIRTHING LEVEL I","code_information":[{"code":"7200011","type":"CDM"},{"code":"0720","type":"RC"},{"code":"7200011","type":"HCPCS"}],"standard_charges":[{"gross_charge":2219.0,"discounted_cash":1331.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BIRTHING LEVEL II","code_information":[{"code":"7200012","type":"CDM"},{"code":"0720","type":"RC"},{"code":"7200012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3322.0,"discounted_cash":1993.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1913.0,"discounted_cash":1147.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2622.0,"discounted_cash":1573.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":5985.0,"discounted_cash":3591.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":6119.0,"discounted_cash":3671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC C-SECTION WITH LABOR","code_information":[{"code":"7200024","type":"CDM"},{"code":"0722","type":"RC"},{"code":"59414","type":"HCPCS"}],"standard_charges":[{"gross_charge":6119.0,"discounted_cash":3671.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC DELIVERY ROOM/SURG PROC","code_information":[{"code":"7200030","type":"CDM"},{"code":"0722","type":"RC"},{"code":"7200030","type":"HCPCS"}],"standard_charges":[{"gross_charge":5464.0,"discounted_cash":3278.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC BIRTHING LEVEL III","code_information":[{"code":"7200052","type":"CDM"},{"code":"0720","type":"RC"},{"code":"7200052","type":"HCPCS"}],"standard_charges":[{"gross_charge":9674.0,"discounted_cash":5804.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":420.0,"discounted_cash":252.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":902.0,"discounted_cash":541.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":902.0,"discounted_cash":541.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":902.0,"discounted_cash":541.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":902.0,"discounted_cash":541.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":530.0,"discounted_cash":318.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":902.0,"discounted_cash":541.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4885.0,"discounted_cash":2931.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1205.0,"discounted_cash":723.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":877.0,"discounted_cash":526.2,"setting":"inpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":6722.0,"discounted_cash":4033.2,"setting":"inpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":7541.0,"discounted_cash":4524.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":8295.0,"discounted_cash":4977.0,"setting":"inpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":8687.0,"discounted_cash":5212.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC EEG AWAKE AND DROWSY-LEVEL II","code_information":[{"code":"7400015","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1231.0,"discounted_cash":738.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1231.0,"discounted_cash":738.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":894.0,"discounted_cash":536.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":135.0,"discounted_cash":81.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 95800 SLEEP STUDY, UNATTENDED BY TECH, SIMULTANEOUS RECORDING","code_information":[{"code":"7400070","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1144.0,"discounted_cash":686.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1687.0,"discounted_cash":1012.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1464.0,"discounted_cash":878.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1220.0,"discounted_cash":732.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2651.0,"discounted_cash":1590.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC HOSPITAL OBSERVATION, PER HOUR","code_information":[{"code":"7620002","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":604.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC DIRECT ADMISSION OBSERVATION CARE","code_information":[{"code":"7620003","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":369.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OBSERVATION CARVE-OUT - CARDIOLOGY","code_information":[{"code":"7620005","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OBSERVATION CARVE-OUT - DIALYSIS","code_information":[{"code":"7620009","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OBSERVATION CARVE-OUT - PROCEDURAL","code_information":[{"code":"7620011","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OBSERVATION CARVE-OUT - REHAB","code_information":[{"code":"7620013","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OBSERVATION CARVE-OUT - ANGIOGRAM","code_information":[{"code":"7620014","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC OBSERVATION CARVE-OUT - SURGICAL","code_information":[{"code":"7620015","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":41.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ESWL-UNILATERAL STONE(S)","code_information":[{"code":"7900001","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"gross_charge":40099.0,"discounted_cash":24059.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ESWL-BILATERAL STONES","code_information":[{"code":"7900002","type":"CDM"},{"code":"0790","type":"RC"}],"standard_charges":[{"gross_charge":46573.0,"discounted_cash":27943.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":17791.0,"discounted_cash":10674.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":3934.0,"discounted_cash":2360.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2012.0,"discounted_cash":1207.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":4984.0,"discounted_cash":2990.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":161.0,"discounted_cash":96.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":414.0,"discounted_cash":248.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2012.0,"discounted_cash":1207.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"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":889.0,"discounted_cash":533.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1298.0,"discounted_cash":778.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2432.0,"discounted_cash":1459.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1141.0,"discounted_cash":684.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":579.0,"discounted_cash":347.4,"setting":"inpatient","modifier_code":["52"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | 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":1594.0,"discounted_cash":956.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1238.0,"discounted_cash":742.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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  COMP BILAT","code_information":[{"code":"9200026","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":1066.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1261.0,"discounted_cash":756.6,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1261.0,"discounted_cash":756.6,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1697.0,"discounted_cash":1018.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1847.0,"discounted_cash":1108.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1163.0,"discounted_cash":697.8,"setting":"inpatient","modifier_code":["RT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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":1163.0,"discounted_cash":697.8,"setting":"inpatient","modifier_code":["LT"],"billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC | The modified price is 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 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":1462.0,"discounted_cash":877.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":773.0,"discounted_cash":463.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1292.0,"discounted_cash":775.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":1156.0,"discounted_cash":693.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"},{"gross_charge":1123.0,"discounted_cash":673.8,"setting":"outpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMCOP"}]},{"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":1566.0,"discounted_cash":939.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC DUPLEX HEMODIALYSIS ACCESS","code_information":[{"code":"9200042","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.0,"discounted_cash":472.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC TENSILON TST MYASTENIA GRAV","code_information":[{"code":"9200050","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95857","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.0,"discounted_cash":391.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":452.0,"discounted_cash":271.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":489.0,"discounted_cash":293.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 94729 DIFFUSING CAPACITY","code_information":[{"code":"9200055","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":253.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":298.0,"discounted_cash":178.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":153.0,"discounted_cash":91.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":78.0,"discounted_cash":46.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC TRACHEOSTOMY,EMERG PROC,TRANSTRACH","code_information":[{"code":"9400001","type":"CDM"},{"code":"0940","type":"RC"},{"code":"31603","type":"HCPCS"}],"standard_charges":[{"gross_charge":4184.0,"discounted_cash":2510.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 36430 BLOOD TRANSFUSION","code_information":[{"code":"9400002","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1515.0,"discounted_cash":909.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":2986.0,"discounted_cash":1791.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":708.0,"discounted_cash":424.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":336.0,"discounted_cash":201.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":826.0,"discounted_cash":495.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":346.0,"discounted_cash":207.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":376.0,"discounted_cash":225.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":350.0,"discounted_cash":210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":250.0,"discounted_cash":150.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":407.0,"discounted_cash":244.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":362.0,"discounted_cash":217.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":350.0,"discounted_cash":210.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":479.0,"discounted_cash":287.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":479.0,"discounted_cash":287.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":264.0,"discounted_cash":158.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 99195 PHLEBOTOMY, THERAPEUTIC","code_information":[{"code":"9400036","type":"CDM"},{"code":"0940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":190.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ADMINISTRATION INFLUENZA VACCINE","code_information":[{"code":"9400039","type":"CDM"},{"code":"0771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":57.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC ADMINISTRATION PNEUMOCOCCAL VACCINE","code_information":[{"code":"9400040","type":"CDM"},{"code":"0771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":104.0,"discounted_cash":62.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":72.0,"discounted_cash":43.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC 96373 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION; INTRA-ARTERIAL","code_information":[{"code":"9400228","type":"CDM"},{"code":"0940","type":"RC"},{"code":"96373","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":186.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":939.0,"discounted_cash":563.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":939.0,"discounted_cash":563.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":939.0,"discounted_cash":563.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":123.0,"discounted_cash":73.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":166.0,"discounted_cash":99.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":119.0,"discounted_cash":71.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":117.0,"discounted_cash":70.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":156.0,"discounted_cash":93.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":229.0,"discounted_cash":137.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":178.0,"discounted_cash":106.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":88.0,"discounted_cash":52.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":205.0,"discounted_cash":123.0,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":126.0,"discounted_cash":75.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":82.0,"discounted_cash":49.2,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":159.0,"discounted_cash":95.4,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":236.0,"discounted_cash":141.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"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":136.0,"discounted_cash":81.6,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"HC DRIVING EVALUATION","code_information":[{"code":"9990274","type":"CDM"},{"code":"0999","type":"RC"},{"code":"9990274","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":76.8,"setting":"inpatient","billing_class":"facility","additional_generic_notes":"Gross Charge Type: SMMC"}]},{"description":"Treat fracture of radius","code_information":[{"code":"25520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Forearm or wrist surgery","code_information":[{"code":"25999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Release palm contracture","code_information":[{"code":"26125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Manipulate finger w/anesth","code_information":[{"code":"26340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Manipulat palm cord post inj","code_information":[{"code":"26341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat thumb dislocation","code_information":[{"code":"26641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for wrist x-ray","code_information":[{"code":"25246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Upper arm/elbow surgery","code_information":[{"code":"24999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for elbow x-ray","code_information":[{"code":"24220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shoulder surgery procedure","code_information":[{"code":"23929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for shoulder x-ray","code_information":[{"code":"23350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"22999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Spine surgery procedure","code_information":[{"code":"22899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruct lesion 15 or more","code_information":[{"code":"17111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruct b9 lesion 1-14","code_information":[{"code":"17110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destroy premal lesions 15/>","code_information":[{"code":"17004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruct premalg les 2-14","code_information":[{"code":"17003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruct premalg lesion","code_information":[{"code":"17000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incision of burn scab initi","code_information":[{"code":"16035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dress/debrid p-thick burn l","code_information":[{"code":"16030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dress/debrid p-thick burn m","code_information":[{"code":"16025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dress/debrid p-thick burn s","code_information":[{"code":"16020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Initial treatment of burn(s)","code_information":[{"code":"16000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Test for blood flow in graft","code_information":[{"code":"15860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal sutr&stapl xreq anes","code_information":[{"code":"15854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal sutr/stapl xreq anes","code_information":[{"code":"15853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dressing change not for burn","code_information":[{"code":"15852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exc Skin Abd Add-on","code_information":[{"code":"15847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemical peel face dermal","code_information":[{"code":"15789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemical peel face epiderm","code_information":[{"code":"15788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Abrasion lesions add-on","code_information":[{"code":"15787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Abrasion lesion single","code_information":[{"code":"15786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dermabrasion suprfl any site","code_information":[{"code":"15783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Acellular derm matrix implt","code_information":[{"code":"15777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Hair trnspl >15 punch grafts","code_information":[{"code":"15776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Hair trnspl 1-15 punch grfts","code_information":[{"code":"15775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Gfrg autol fat lipo ea addl","code_information":[{"code":"15774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr f/e/e/n/l/m >30.0 cm","code_information":[{"code":"12018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr fe/e/en/l/m 20.1-30.0 cm","code_information":[{"code":"12017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr fe/e/en/l/m 12.6-20.0 cm","code_information":[{"code":"12016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr f/e/e/n/l/m 7.6-12.5 cm","code_information":[{"code":"12015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr f/e/e/n/l/m 5.1-7.5 cm","code_information":[{"code":"12014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr f/e/e/n/l/m 2.6-5.0 cm","code_information":[{"code":"12013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr f/e/e/n/l/m 2.5 cm/<","code_information":[{"code":"12011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr s/n/ax/gen/trnk >30.0 cm","code_information":[{"code":"12007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr s/n/a/gen/trk20.1-30.0cm","code_information":[{"code":"12006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr s/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"12005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr s/n/ax/gen/trk7.6-12.5cm","code_information":[{"code":"12004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr s/n/ax/gen/trnk2.6-7.5cm","code_information":[{"code":"12002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rpr s/n/ax/gen/trnk 2.5cm/<","code_information":[{"code":"12001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove/insert drug implant","code_information":[{"code":"11983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove drug implant device","code_information":[{"code":"11982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert drug implant device","code_information":[{"code":"11981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Implant hormone pellet(s)","code_information":[{"code":"11980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tx contour defects 5.1-10cc","code_information":[{"code":"11952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tx contour defects 1.1-5.0cc","code_information":[{"code":"11951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tx contour defects 1 cc/<","code_information":[{"code":"11950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Correct skin color ea 20.0cm","code_information":[{"code":"11922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Correct skn color 6.1-20.0cm","code_information":[{"code":"11921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Correct skin color 6.0 cm/<","code_information":[{"code":"11920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject skin lesions >7","code_information":[{"code":"11901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject skin lesions <=w 7","code_information":[{"code":"11900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Excision of nail fold toe","code_information":[{"code":"11765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair of nail bed","code_information":[{"code":"11760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Second level cer diskectomy","code_information":[{"code":"22858","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22854","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj biomechanical device","code_information":[{"code":"22853","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert pelv fixation device","code_information":[{"code":"22848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert spine fixation device","code_information":[{"code":"22840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Spine fusion extra segment","code_information":[{"code":"22614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Lat thor/lumb addl seg","code_information":[{"code":"22534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Vertebroplasty addl inject","code_information":[{"code":"22512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat each add spine fx","code_information":[{"code":"22328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Closed tx vert fx w/o manj","code_information":[{"code":"22310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise extra spine segment","code_information":[{"code":"22226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incis addl spine segment","code_information":[{"code":"22216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incis spine 3 column adl seg","code_information":[{"code":"22208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove extra spine segment","code_information":[{"code":"22116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove extra spine segment","code_information":[{"code":"22103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Neck/chest surgery procedure","code_information":[{"code":"21899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Head surgery procedure","code_information":[{"code":"21499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Closed tx orbit w/o manipulj","code_information":[{"code":"21400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cranio/maxillofacial surgery","code_information":[{"code":"21299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection jaw joint x-ray","code_information":[{"code":"21116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21089","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Musculoskeletal surgery","code_information":[{"code":"20999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cptr-asst dir ms px","code_information":[{"code":"20985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Us bone stimulation","code_information":[{"code":"20979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.99,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.61,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56.83,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bone marrow aspir bone grfg","code_information":[{"code":"20939","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intercalary algrft compl","code_information":[{"code":"20934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Hemicrt intrclry algrft prtl","code_information":[{"code":"20933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Osteoart algrft w/surf & b1","code_information":[{"code":"20932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Sp bone algrft struct add-on","code_information":[{"code":"20931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Sp bone algrft morsel add-on","code_information":[{"code":"20930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove cartilage for graft","code_information":[{"code":"20910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl i-artic rx delivery dev","code_information":[{"code":"20705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mnl prep&insj i-artic rx dev","code_information":[{"code":"20704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl imed rx delivery device","code_information":[{"code":"20703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mnl prep&insj imed rx dev","code_information":[{"code":"20702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl deep rx delivery device","code_information":[{"code":"20701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mnl prep&insj dp rx dlvr dev","code_information":[{"code":"20700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal of fixation device","code_information":[{"code":"20665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Aspirate/inj ganglion cyst","code_information":[{"code":"20612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain/inj joint/bursa w/o us","code_information":[{"code":"20600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ndl insj w/o njx 3+ musc","code_information":[{"code":"20561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.99,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.61,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ndl insj w/o njx 1 or 2 musc","code_information":[{"code":"20560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.99,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31.61,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject trigger points 3/>","code_information":[{"code":"20553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj trigger point 1/2 muscl","code_information":[{"code":"20552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj tendon origin/insertion","code_information":[{"code":"20551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj tendon sheath/ligament","code_information":[{"code":"20550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj dupuytren cord w/enzyme","code_information":[{"code":"20527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ther injection carp tunnel","code_information":[{"code":"20526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject sinus tract for x-ray","code_information":[{"code":"20501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Explore wound neck","code_information":[{"code":"20100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prep tum cav iort prtl mast","code_information":[{"code":"19294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq dev breast add mr guide","code_information":[{"code":"19288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq dev breast add us imag","code_information":[{"code":"19286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq dev breast add strtctc","code_information":[{"code":"19284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq device breast ea imag","code_information":[{"code":"19282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Excision addl breast lesion","code_information":[{"code":"19126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bx breast add lesion mr imag","code_information":[{"code":"19086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bx breast add lesion us imag","code_information":[{"code":"19084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bx breast add lesion strtctc","code_information":[{"code":"19082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for breast x-ray","code_information":[{"code":"19030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain breast lesion add-on","code_information":[{"code":"19001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin tissue procedure","code_information":[{"code":"17999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Hair removal by electrolysis","code_information":[{"code":"17380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin peel therapy","code_information":[{"code":"17360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cryotherapy of skin","code_information":[{"code":"17340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mohs surg addl block","code_information":[{"code":"17315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mohs addl stage t/a/l","code_information":[{"code":"17314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mohs 1 stage t/a/l","code_information":[{"code":"17313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mohs Addl Stage","code_information":[{"code":"17312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mohs 1 stage h/n/hf/g","code_information":[{"code":"17311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemical cautery tissue","code_information":[{"code":"17250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Grfg autol fat lipo ea addl","code_information":[{"code":"15772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skn sub grft f/n/hf/g ch add","code_information":[{"code":"15278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin sub graft f/n/hf/g addl","code_information":[{"code":"15276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skn sub grft t/a/l child add","code_information":[{"code":"15274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin sub graft t/a/l add-on","code_information":[{"code":"15272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin full graft add-on","code_information":[{"code":"15221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin full graft trunk add-on","code_information":[{"code":"15201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cult epiderm grft f/n/hfg +%","code_information":[{"code":"15157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cult skin grft f/n/hfg add","code_information":[{"code":"15156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cult skin graft t/a/l +%","code_information":[{"code":"15152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cult skin grft t/a/l addl","code_information":[{"code":"15151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Derm autograft f/n/hf/g add","code_information":[{"code":"15136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Derm autograft t/a/l add-on","code_information":[{"code":"15131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skn splt a-grft f/n/hf/g add","code_information":[{"code":"15121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Epidrm a-grft f/n/hf/g addl","code_information":[{"code":"15116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Epidrm autogrft t/a/l add-on","code_information":[{"code":"15111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin splt grft t/a/l add-on","code_information":[{"code":"15101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Skin pinch graft","code_information":[{"code":"15050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Wnd prep f/n/hf/g addl cm","code_information":[{"code":"15005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Wound prep f/n/hf/g","code_information":[{"code":"15004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Wound prep addl 100 cm","code_information":[{"code":"15003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tis trnfr addl 30 sq cm/<","code_information":[{"code":"14302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr e/n/e/l addl 5cm/<","code_information":[{"code":"13153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr e/n/e/l 2.6-7.5 cm","code_information":[{"code":"13152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr e/n/e/l 1.1-2.5 cm","code_information":[{"code":"13151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr s/a/l addl 5 cm/>","code_information":[{"code":"13122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr s/a/l 2.6-7.5 cm","code_information":[{"code":"13121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr s/a/l 1.1-2.5 cm","code_information":[{"code":"13120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr trunk addl 5cm/<","code_information":[{"code":"13102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr trunk 2.6-7.5 cm","code_information":[{"code":"13101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cmplx rpr trunk 1.1-2.5 cm","code_information":[{"code":"13100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr face/mm >30.0 cm","code_information":[{"code":"12057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr face/mm 20.1-30.0","code_information":[{"code":"12056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr face/mm 12.6-20 cm","code_information":[{"code":"12055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr face/mm 7.6-12.5cm","code_information":[{"code":"12054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr face/mm 5.1-7.5 cm","code_information":[{"code":"12053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr face/mm 2.6-5.0 cm","code_information":[{"code":"12052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr face/mm 2.5 cm/<","code_information":[{"code":"12051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr n-hf/genit12.6-20","code_information":[{"code":"12045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr n-hf/genit7.6-12.5","code_information":[{"code":"12044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr n-hf/genit2.6-7.5","code_information":[{"code":"12042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr n-hf/genit 2.5cm/<","code_information":[{"code":"12041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr s/a/t/ext 20.1-30","code_information":[{"code":"12036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr s/a/t/ext 12.6-20","code_information":[{"code":"12035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr s/tr/ext 7.6-12.5","code_information":[{"code":"12034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr s/a/t/ext 2.6-7.5","code_information":[{"code":"12032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intmd rpr s/a/t/ext 2.5 cm/<","code_information":[{"code":"12031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Closure of split wound","code_information":[{"code":"12021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Closure of split wound","code_information":[{"code":"12020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal of nail bed","code_information":[{"code":"11750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain blood from under nail","code_information":[{"code":"11740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove nail plate add-on","code_information":[{"code":"11732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal of nail plate","code_information":[{"code":"11730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Debride nail 6 or more","code_information":[{"code":"11721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Debride nail 1-5","code_information":[{"code":"11720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trim nail(s) any number","code_information":[{"code":"11719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exc tr-ext mal+marg 1.1-2 cm","code_information":[{"code":"11602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exc tr-ext b9+marg 0.6-1 cm","code_information":[{"code":"11401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 0.6-1.0 cm","code_information":[{"code":"11301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove skin tags add-on","code_information":[{"code":"11201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal of skin tags <w/15","code_information":[{"code":"11200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incal bx skn ea sep/addl","code_information":[{"code":"11107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Punch bx skin ea sep/addl","code_information":[{"code":"11105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Punch bx skin single lesion","code_information":[{"code":"11104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tangntl bx skin ea sep/addl","code_information":[{"code":"11103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tangntl bx skin single les","code_information":[{"code":"11102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trim skin lesions over 4","code_information":[{"code":"11057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trim skin lesions 2 to 4","code_information":[{"code":"11056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trim skin lesion","code_information":[{"code":"11055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Deb bone add-on","code_information":[{"code":"11047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Deb musc/fascia add-on","code_information":[{"code":"11046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Deb subq tissue add-on","code_information":[{"code":"11045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Deb musc/fascia 20 sq cm/<","code_information":[{"code":"11043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Deb subq tissue 20 sq cm/<","code_information":[{"code":"11042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Debride infected skin add-on","code_information":[{"code":"11001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Debride infected skin","code_information":[{"code":"11000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Puncture drainage of lesion","code_information":[{"code":"10160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove foreign body","code_information":[{"code":"10120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Acne surgery","code_information":[{"code":"10040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq dev soft tiss add imag","code_information":[{"code":"10036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna w/o image","code_information":[{"code":"10021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna bx w/mr gdn ea addl","code_information":[{"code":"10012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna bx w/ct gdn ea addl","code_information":[{"code":"10010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna bx w/fluor gdn ea addl","code_information":[{"code":"10008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna bx w/us gdn ea addl","code_information":[{"code":"10006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna bx w/o img gdn ea addl","code_information":[{"code":"10004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fusion of finger jnt add-on","code_information":[{"code":"26861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fuse/graft added joint","code_information":[{"code":"26863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Hand/finger surgery","code_information":[{"code":"26989","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for hip x-ray","code_information":[{"code":"27093","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for hip x-ray","code_information":[{"code":"27095","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject sacroiliac joint","code_information":[{"code":"27096","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clsd tx pelvic ring fx","code_information":[{"code":"27198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat hip socket fracture","code_information":[{"code":"27222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Pelvis/hip joint surgery","code_information":[{"code":"27299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove femur lesion/fixation","code_information":[{"code":"27358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx cntrst kne arthg/ct/mri","code_information":[{"code":"27369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of figure eight","code_information":[{"code":"29049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of shoulder cast","code_information":[{"code":"29058","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of long arm cast","code_information":[{"code":"29065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of forearm cast","code_information":[{"code":"29075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply hand/wrist cast","code_information":[{"code":"29085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply finger cast","code_information":[{"code":"29086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply long arm splint","code_information":[{"code":"29105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of finger splint","code_information":[{"code":"29130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of finger splint","code_information":[{"code":"29131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of chest","code_information":[{"code":"29200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of shoulder","code_information":[{"code":"29240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of elbow or wrist","code_information":[{"code":"29260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of hand or finger","code_information":[{"code":"29280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of hip cast","code_information":[{"code":"29305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of hip casts","code_information":[{"code":"29325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply long leg cast brace","code_information":[{"code":"29358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of long leg cast","code_information":[{"code":"29365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply short leg cast","code_information":[{"code":"29435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Addition of walker to cast","code_information":[{"code":"29440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply rigid leg cast","code_information":[{"code":"29445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of leg cast","code_information":[{"code":"29450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application long leg splint","code_information":[{"code":"29505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application lower leg splint","code_information":[{"code":"29515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of hip","code_information":[{"code":"29520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of knee","code_information":[{"code":"29530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of ankle and/or ft","code_information":[{"code":"29540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Strapping of toes","code_information":[{"code":"29550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of paste boot","code_information":[{"code":"29580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply multlay comprs lwr leg","code_information":[{"code":"29581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Appl multlay comprs arm/hand","code_information":[{"code":"29584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal/revision of cast","code_information":[{"code":"29710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair of body cast","code_information":[{"code":"29720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Windowing of cast","code_information":[{"code":"29730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Wedging of cast","code_information":[{"code":"29740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Wedging of clubfoot cast","code_information":[{"code":"29750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Casting/strapping procedure","code_information":[{"code":"29799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Arthroscopy of joint","code_information":[{"code":"29999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of nose lesion","code_information":[{"code":"30020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection treatment of nose","code_information":[{"code":"30200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Release of nasal adhesions","code_information":[{"code":"30560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repeat control of nosebleed","code_information":[{"code":"30906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nasal surgery procedure","code_information":[{"code":"30999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Irrigation maxillary sinus","code_information":[{"code":"31000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nasal endoscopy dx","code_information":[{"code":"31231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.90,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Sinus surgery procedure","code_information":[{"code":"31299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert emergency airway","code_information":[{"code":"31500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Change of windpipe airway","code_information":[{"code":"31502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.90,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove foreign body larynx","code_information":[{"code":"31511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.90,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection into vocal cord","code_information":[{"code":"31513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Laryngoscopy for aspiration","code_information":[{"code":"31515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dx laryngoscopy newborn","code_information":[{"code":"31520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Diagnostic laryngoscopy","code_information":[{"code":"31575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.90,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Largsc w/rmvl foreign bdy(s)","code_information":[{"code":"31577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Laryngoscopy telescopic","code_information":[{"code":"31579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Larynx surgery procedure","code_information":[{"code":"31599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Visualization of windpipe","code_information":[{"code":"31615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Navigational bronchoscopy","code_information":[{"code":"31627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bronchoscopy/lung bx addl","code_information":[{"code":"31632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bronchoscopy/needle bx addl","code_information":[{"code":"31633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bronchoscopy stent add-on","code_information":[{"code":"31637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bronchoscopy reclear airway","code_information":[{"code":"31646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bronchial valve addl insert","code_information":[{"code":"31651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bronch ebus ivntj perph les","code_information":[{"code":"31654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bronchial brush biopsy","code_information":[{"code":"31717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":419.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":423.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":427.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":419.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clearance of airways","code_information":[{"code":"31720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.66,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":237.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":239.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":234.66,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Airways surgical procedure","code_information":[{"code":"31899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":213.90,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.04,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":213.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tcat plmt&rmvl cepd perq","code_information":[{"code":"33370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair tcat mitral valve","code_information":[{"code":"33419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endoscopic vein harvest","code_information":[{"code":"33508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Aortic hemiarch graft","code_information":[{"code":"33866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq p-art revsc each addl","code_information":[{"code":"33904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq access & clsr fem art","code_information":[{"code":"34713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Opn fem art expos cndt crtj","code_information":[{"code":"34714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Opn ax/subcla art expos","code_information":[{"code":"34715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Opn ax/subcla art expos cndt","code_information":[{"code":"34716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Harvest vein for bypass","code_information":[{"code":"35500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Harvest femoropopliteal vein","code_information":[{"code":"35572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bypass graft patency/patch","code_information":[{"code":"35685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bypass graft/av fist patency","code_information":[{"code":"35686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place needle in vein","code_information":[{"code":"36000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection ext venography","code_information":[{"code":"36005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in vein","code_information":[{"code":"36010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat knee fracture(s)","code_information":[{"code":"27538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Leg surgery procedure","code_information":[{"code":"27599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for ankle x-ray","code_information":[{"code":"27648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise additional leg tendon","code_information":[{"code":"27692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cltx medial ankle fx","code_information":[{"code":"27760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cltx post ankle fx","code_information":[{"code":"27767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cltx post ankle fx w/mnpj","code_information":[{"code":"27768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Leg/ankle surgery procedure","code_information":[{"code":"27899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1757.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of toe fracture","code_information":[{"code":"28515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Foot/toes surgery procedure","code_information":[{"code":"28899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":264.33,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":266.98,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":269.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":264.33,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":299.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":302.72,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":305.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Application of body cast","code_information":[{"code":"29044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":175.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":177.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":174.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endoscopic pancreatoscopy","code_information":[{"code":"43273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nasal/orogastric w/tube plmt","code_information":[{"code":"43752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tx gastro intub w/asp","code_information":[{"code":"43753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dx gastr intub w/asp spec","code_information":[{"code":"43754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dx gastr intub w/asp specs","code_information":[{"code":"43755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Reposition gastrostomy tube","code_information":[{"code":"43761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rplc gtube no revj trc","code_information":[{"code":"43762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rplc gtube  revj gstrst trc","code_information":[{"code":"43763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intraop colon lavage add-on","code_information":[{"code":"44701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Appendectomy add-on","code_information":[{"code":"44955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incise external hemorrhoid","code_information":[{"code":"46083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Diagnostic anoscopy spx","code_information":[{"code":"46600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Diagnostic anoscopy","code_information":[{"code":"46601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cryosurgery anal lesion(s)","code_information":[{"code":"46916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Needle biopsy liver add-on","code_information":[{"code":"47001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilate biliary duct/ampulla","code_information":[{"code":"47542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endoluminal bx biliary tree","code_information":[{"code":"47543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal duct glbldr calculi","code_information":[{"code":"47544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Lap w/Omentopexy Add-on","code_information":[{"code":"49326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Lap ins device for rt","code_information":[{"code":"49327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Air injection into abdomen","code_information":[{"code":"49400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Assess cyst contrast inject","code_information":[{"code":"49424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection abdominal shunt","code_information":[{"code":"49427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fluoro exam of g/colon tube","code_information":[{"code":"49465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":255.69,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.25,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":260.8,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":255.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl ninfct mesh hernia rpr","code_information":[{"code":"49623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Instll rx agnt into rnal tub","code_information":[{"code":"50391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endoluminal bx urtr rnl plvs","code_information":[{"code":"50606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for ureter x-ray","code_information":[{"code":"50684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Measure ureter pressure","code_information":[{"code":"50686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for ureter x-ray","code_information":[{"code":"50690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ureteral embolization/occl","code_information":[{"code":"50705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Balloon dilate urtrl strix","code_information":[{"code":"50706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drain bladder by needle","code_information":[{"code":"51100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for bladder x-ray","code_information":[{"code":"51600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Preparation for bladder xray","code_information":[{"code":"51605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for bladder x-ray","code_information":[{"code":"51610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Irrigation of bladder","code_information":[{"code":"51700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert bladder catheter","code_information":[{"code":"51701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert temp bladder cath","code_information":[{"code":"51702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert bladder cath complex","code_information":[{"code":"51703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Change of bladder tube","code_information":[{"code":"51705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of bladder lesion","code_information":[{"code":"51720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Simple cystometrogram","code_information":[{"code":"51725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Complex cystometrogram","code_information":[{"code":"51726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Urine flow measurement","code_information":[{"code":"51736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electro-uroflowmetry first","code_information":[{"code":"51741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Urinary reflex study","code_information":[{"code":"51792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intraabdominal pressure test","code_information":[{"code":"51797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Us urine capacity measure","code_information":[{"code":"51798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cystourethro w/implant","code_information":[{"code":"52441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cystourethro w/addl implant","code_information":[{"code":"52442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tprnl balo cntnc dev adjmt","code_information":[{"code":"53454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Urology surgery procedure","code_information":[{"code":"53899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cryosurgery penis lesion(s)","code_information":[{"code":"54056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prepare penis study","code_information":[{"code":"54230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Penile injection","code_information":[{"code":"54235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Penis study","code_information":[{"code":"54240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Penis study","code_information":[{"code":"54250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remov/replc penis pros comp","code_information":[{"code":"54411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":22654.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22432.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22654.71,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22210.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Preputial stretching","code_information":[{"code":"54450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prepare sperm duct x-ray","code_information":[{"code":"55300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Genital surgery procedure","code_information":[{"code":"55899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"I & D of vulva/perineum","code_information":[{"code":"56405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of gland abscess","code_information":[{"code":"56420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy of vulva/perineum","code_information":[{"code":"56606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exam of vulva w/scope","code_information":[{"code":"56820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exam/biopsy of vulva w/scope","code_information":[{"code":"56821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in vein","code_information":[{"code":"36011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in vein","code_information":[{"code":"36012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Establish access to artery","code_information":[{"code":"36100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Establish access to artery","code_information":[{"code":"36140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Establish access to aorta","code_information":[{"code":"36160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in aorta","code_information":[{"code":"36200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place catheter in artery","code_information":[{"code":"36218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place cath xtrnl carotid","code_information":[{"code":"36227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Place cath intracranial art","code_information":[{"code":"36228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ins cath abd/l-ext art 1st","code_information":[{"code":"36245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ins cath abd/l-ext art 2nd","code_information":[{"code":"36246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ins cath abd/l-ext art 3rd","code_information":[{"code":"36247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ins cath abd/l-ext art addl","code_information":[{"code":"36248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Vessel injection procedure","code_information":[{"code":"36299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Vein access cutdown < 1 yr","code_information":[{"code":"36420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Vein access cutdown > 1 yr","code_information":[{"code":"36425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Blood transfusion service","code_information":[{"code":"36430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bl push transfuse 2 yr/<","code_information":[{"code":"36440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bl exchange/transfuse nb","code_information":[{"code":"36450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bl exchange/transfuse non-nb","code_information":[{"code":"36455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prtl exchange transfuse nb","code_information":[{"code":"36456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Transfusion service fetal","code_information":[{"code":"36460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection(s) spider veins","code_information":[{"code":"36468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection therapy of vein","code_information":[{"code":"36470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection therapy of veins","code_information":[{"code":"36471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":435.63,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":439.99,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":444.34,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":435.63,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endovenous mchnchem add-on","code_information":[{"code":"36474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endovenous rf vein add-on","code_information":[{"code":"36476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endovenous laser vein addon","code_information":[{"code":"36479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insertion of catheter vein","code_information":[{"code":"36481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endoven ther chem adhes sbsq","code_information":[{"code":"36483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insertion of catheter vein","code_information":[{"code":"36500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insertion of catheter vein","code_information":[{"code":"36510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apheresis platelets","code_information":[{"code":"36513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Draw blood off venous device","code_information":[{"code":"36591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Collect blood from picc","code_information":[{"code":"36592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Declot vascular device","code_information":[{"code":"36593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.96,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj w/fluor eval cv device","code_information":[{"code":"36598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":227.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":230.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":232.5,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":227.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Withdrawal of arterial blood","code_information":[{"code":"36600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert needle bone cavity","code_information":[{"code":"36680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Balo angiop ctr dialysis seg","code_information":[{"code":"36907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Stent plmt ctr dialysis seg","code_information":[{"code":"36908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dialysis circuit embolj","code_information":[{"code":"36909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prim art m-thrmbc sbsq vsl","code_information":[{"code":"37185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Sec art thrombectomy add-on","code_information":[{"code":"37186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Thrombolytic therapy stroke","code_information":[{"code":"37195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.96,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trluml balo angiop addl art","code_information":[{"code":"37247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trluml balo angiop addl vein","code_information":[{"code":"37249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intrvasc us noncoronary 1st","code_information":[{"code":"37252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intrvasc us noncoronary addl","code_information":[{"code":"37253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for spleen x-ray","code_information":[{"code":"38200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Harvest allogeneic stem cell","code_information":[{"code":"38205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cryopreserve stem cells","code_information":[{"code":"38207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Thaw preserved stem cells","code_information":[{"code":"38208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Wash harvest stem cells","code_information":[{"code":"38209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"T-cell depletion of harvest","code_information":[{"code":"38210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tumor cell deplete of harvst","code_information":[{"code":"38211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rbc depletion of harvest","code_information":[{"code":"38212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Platelet deplete of harvest","code_information":[{"code":"38213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Volume deplete of harvest","code_information":[{"code":"38214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Harvest stem cell concentrte","code_information":[{"code":"38215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject for lymphatic x-ray","code_information":[{"code":"38790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ra tracer id of sentinl node","code_information":[{"code":"38792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.40,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":432.69,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":436.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":428.4,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Access thoracic lymph duct","code_information":[{"code":"38794","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Io map of sent lymph node","code_information":[{"code":"38900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Blood/lymph system procedure","code_information":[{"code":"38999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":472.77,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":477.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":482.23,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":472.77,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy of lip","code_information":[{"code":"40490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair lip","code_information":[{"code":"40650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair lip","code_information":[{"code":"40652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Lip surgery procedure","code_information":[{"code":"40799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incision of lip fold","code_information":[{"code":"40806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy of mouth lesion","code_information":[{"code":"40808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Excise oral mucosa for graft","code_information":[{"code":"40818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair mouth laceration","code_information":[{"code":"40830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair mouth laceration","code_information":[{"code":"40831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Mouth surgery procedure","code_information":[{"code":"40899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy of tongue","code_information":[{"code":"41100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair tongue laceration","code_information":[{"code":"41252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tongue and mouth surgery","code_information":[{"code":"41599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of gum lesion","code_information":[{"code":"41800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dental surgery procedure","code_information":[{"code":"41899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage mouth roof lesion","code_information":[{"code":"42000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair palate","code_information":[{"code":"42180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Preparation palate mold","code_information":[{"code":"42280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Palate/uvula surgery","code_information":[{"code":"42299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for salivary x-ray","code_information":[{"code":"42550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilation of salivary duct","code_information":[{"code":"42660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Salivary surgery procedure","code_information":[{"code":"42699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of tonsil abscess","code_information":[{"code":"42700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove pharynx foreign body","code_information":[{"code":"42809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Control throat bleeding","code_information":[{"code":"42960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dise eval slp do brth flx dx","code_information":[{"code":"42975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1945.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Throat surgery procedure","code_information":[{"code":"42999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of corneal lesion","code_information":[{"code":"65450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prep corneal endo allograft","code_information":[{"code":"65757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of eye","code_information":[{"code":"65800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":2522.57,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incision of iris","code_information":[{"code":"66500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":2522.57,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incision secondary cataract","code_information":[{"code":"66820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":2522.57,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ophthalmic endoscope add-on","code_information":[{"code":"66990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection eye drug","code_information":[{"code":"67028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.96,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of retina","code_information":[{"code":"67141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of retinal lesion","code_information":[{"code":"67208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Eye photodynamic ther add-on","code_information":[{"code":"67225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise eye muscle(s) add-on","code_information":[{"code":"67320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Eye surgery follow-up add-on","code_information":[{"code":"67331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rerevise eye muscles add-on","code_information":[{"code":"67332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise eye muscle w/suture","code_information":[{"code":"67334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Eye suture during surgery","code_information":[{"code":"67335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise eye muscle add-on","code_information":[{"code":"67340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destroy nerve of eye muscle","code_information":[{"code":"67345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Unlisted px extraocular musc","code_information":[{"code":"67399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject/treat eye socket","code_information":[{"code":"67500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject/treat eye socket","code_information":[{"code":"67505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject/treat eye socket","code_information":[{"code":"67515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Orbit surgery procedure","code_information":[{"code":"67599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drainage of eyelid abscess","code_information":[{"code":"67700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove eyelid lesion","code_information":[{"code":"67800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove eyelid lesions","code_information":[{"code":"67805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy eyelid & lid margin","code_information":[{"code":"67810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove eyelid foreign body","code_information":[{"code":"67938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revision of eyelid","code_information":[{"code":"67999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treatment of eyelid lesions","code_information":[{"code":"68040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat eyelid by injection","code_information":[{"code":"68200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Eyelid lining surgery","code_information":[{"code":"68399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incise tear duct opening","code_information":[{"code":"68440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clearance of tear duct","code_information":[{"code":"68530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise tear duct opening","code_information":[{"code":"68705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Close tear duct opening","code_information":[{"code":"68760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Close tear duct opening","code_information":[{"code":"68761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dilate tear duct opening","code_information":[{"code":"68801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Probe nasolacrimal duct","code_information":[{"code":"68810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Explore/irrigate tear ducts","code_information":[{"code":"68840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj rx elut implt lac canal","code_information":[{"code":"68841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":2598.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2598.71,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2547.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for tear sac x-ray","code_information":[{"code":"68850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tear duct system surgery","code_information":[{"code":"68899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.14,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":343.54,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":346.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":340.14,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy of external ear","code_information":[{"code":"69100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clean out mastoid cavity","code_information":[{"code":"69220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clean out mastoid cavity","code_information":[{"code":"69222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Outer ear surgery procedure","code_information":[{"code":"69399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Create eardrum opening","code_information":[{"code":"69433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Middle ear surgery procedure","code_information":[{"code":"69799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inner ear surgery procedure","code_information":[{"code":"69949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Temporal bone surgery","code_information":[{"code":"69979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":253.81,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":256.35,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":258.89,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":253.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Microsurgery add-on","code_information":[{"code":"69990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Esophagus motility study","code_information":[{"code":"91010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Esophgl motil w/stim/perfus","code_information":[{"code":"91013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Gastric motility studies","code_information":[{"code":"91020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Duodenal motility study","code_information":[{"code":"91022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Acid perfusion of esophagus","code_information":[{"code":"91030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Gastroesophageal reflux test","code_information":[{"code":"91034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"G-esoph reflx tst w/electrod","code_information":[{"code":"91035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":929.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":938.65,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":920.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Esoph imped function test","code_information":[{"code":"91037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Esoph imped funct test > 1hr","code_information":[{"code":"91038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Esoph balloon distension tst","code_information":[{"code":"91040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Breath hydrogen/methane test","code_information":[{"code":"91065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Colon motility 6 hr study","code_information":[{"code":"91117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rectal sensation test","code_information":[{"code":"91120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Anal pressure record","code_information":[{"code":"91122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrogastrography","code_information":[{"code":"91132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrogastrography W/Test","code_information":[{"code":"91133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Gastroenterology procedure","code_information":[{"code":"91299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ear and throat examination","code_information":[{"code":"92502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.95,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":583.73,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":577.95,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Heart/lung resuscitation cpr","code_information":[{"code":"92950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.39,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":233.7,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":236.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":231.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prq coronary mech thrombect","code_information":[{"code":"92973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cath place cardio brachytx","code_information":[{"code":"92974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat vagina infection","code_information":[{"code":"57150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ins vag brachytx device","code_information":[{"code":"57156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert pessary/other device","code_information":[{"code":"57160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fitting of diaphragm/cap","code_information":[{"code":"57170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Treat vaginal bleeding","code_information":[{"code":"57180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert mesh/pelvic flr addon","code_information":[{"code":"57267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exam of vagina w/scope","code_information":[{"code":"57420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exam of cervix w/scope","code_information":[{"code":"57452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bx/curett of cervix w/scope","code_information":[{"code":"57454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy of cervix w/scope","code_information":[{"code":"57455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endocerv curettage w/scope","code_information":[{"code":"57456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cam cervix uteri drg colp","code_information":[{"code":"57465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cryocautery of cervix","code_information":[{"code":"57511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Biopsy of uterus lining","code_information":[{"code":"58100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bx done w/colposcopy add-on","code_information":[{"code":"58110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert intrauterine device","code_information":[{"code":"58300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove intrauterine device","code_information":[{"code":"58301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Artificial insemination","code_information":[{"code":"58321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Artificial insemination","code_information":[{"code":"58322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Sperm washing","code_information":[{"code":"58323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Catheter for hysterography","code_information":[{"code":"58340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Hysteroscope procedure","code_information":[{"code":"58579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Transfer of embryo","code_information":[{"code":"58976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Genital surgery procedure","code_information":[{"code":"58999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Amniocentesis therapeutic","code_information":[{"code":"59001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal cord puncture prenatal","code_information":[{"code":"59012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal contract stress test","code_information":[{"code":"59020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal non-stress test","code_information":[{"code":"59025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal scalp blood sample","code_information":[{"code":"59030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal monitor w/report","code_information":[{"code":"59050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Transabdom amnioinfus w/us","code_information":[{"code":"59070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Umbilical cord occlud w/us","code_information":[{"code":"59072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal fluid drainage w/us","code_information":[{"code":"59074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal shunt placement w/us","code_information":[{"code":"59076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert cervical dilator","code_information":[{"code":"59200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Abortion (mpr)","code_information":[{"code":"59866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":326.55,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":333.09,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326.55,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fetal invas px w/us","code_information":[{"code":"59897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Maternity care procedure","code_information":[{"code":"59899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":216.65,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":218.82,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":220.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216.65,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Autotransplant parathyroid","code_information":[{"code":"60512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove brain canal fluid","code_information":[{"code":"61050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Scan proc cranial intra","code_information":[{"code":"61781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Scan proc cranial extra","code_information":[{"code":"61782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Scan proc spinal","code_information":[{"code":"61783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Apply srs headframe add-on","code_information":[{"code":"61800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Neuroendoscopy add-on","code_information":[{"code":"62160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Csf Shunt Reprogram","code_information":[{"code":"62252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Injection for myelogram","code_information":[{"code":"62284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject for spine disk x-ray","code_information":[{"code":"62290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject for spine disk x-ray","code_information":[{"code":"62291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Analyze spine infus pump","code_information":[{"code":"62367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Analyze sp inf pump w/reprog","code_information":[{"code":"62368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Anal sp inf pmp w/reprg&fill","code_information":[{"code":"62369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Anl sp inf pmp w/mdreprg&fil","code_information":[{"code":"62370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Spinal disk surgery add-on","code_information":[{"code":"63035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove spinal lamina add-on","code_information":[{"code":"63048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Lam facetc/frmt arthrd lum 1","code_information":[{"code":"63052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dissolve clot heart vessel","code_information":[{"code":"92977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endoluminl ivus oct c 1st","code_information":[{"code":"92978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Endoluminl ivus oct c ea","code_information":[{"code":"92979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"L hrt cath trnsptl puncture","code_information":[{"code":"93462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Drug admin & hemodynmic meas","code_information":[{"code":"93463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Exercise w/hemodynamic meas","code_information":[{"code":"93464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject congenital card cath","code_information":[{"code":"93563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Lam factc/frmt arthrd lum ea","code_information":[{"code":"63053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Decompress spine cord add-on","code_information":[{"code":"63057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Decompress spine cord add-on","code_information":[{"code":"63066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"N block inj trigeminal","code_information":[{"code":"64400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"N block inj occipital","code_information":[{"code":"64405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"N block inj vagus","code_information":[{"code":"64408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"N block inj plantar digit","code_information":[{"code":"64455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Pvb thoracic 2nd+ inj site","code_information":[{"code":"64462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj foramen epidural add-on","code_information":[{"code":"64480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj foramen epidural add-on","code_information":[{"code":"64484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tap block unil by injection","code_information":[{"code":"64486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tap block uni by infusion","code_information":[{"code":"64487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tap block bi injection","code_information":[{"code":"64488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tap block bi by infusion","code_information":[{"code":"64489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj paravert f jnt c/t 2 lev","code_information":[{"code":"64491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj paravert f jnt c/t 3 lev","code_information":[{"code":"64492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj paravert f jnt l/s 2 lev","code_information":[{"code":"64494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inj paravert f jnt l/s 3 lev","code_information":[{"code":"64495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"N block spenopalatine gangl","code_information":[{"code":"64505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Neuroeltrd stim post tibial","code_information":[{"code":"64566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodenerv saliv glands","code_information":[{"code":"64611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destroy nerve face muscle","code_information":[{"code":"64612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodenerv musc migraine","code_information":[{"code":"64615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodenerv musc neck dyston","code_information":[{"code":"64616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodener muscle larynx emg","code_information":[{"code":"64617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trml dstrj ios bvn ea addl","code_information":[{"code":"64629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject hrt congntl art/grft","code_information":[{"code":"93564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject l ventr/atrial angio","code_information":[{"code":"93565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject r ventr/atrial angio","code_information":[{"code":"93566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject suprvlv aortography","code_information":[{"code":"93567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject pulm art hrt cath","code_information":[{"code":"93568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx cth slct p-art angrp uni","code_information":[{"code":"93569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Heart flow reserve measure","code_information":[{"code":"93571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Heart flow reserve measure","code_information":[{"code":"93572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx cath slct p-art angrp bi","code_information":[{"code":"93573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx cath slct pulm vn angrph","code_information":[{"code":"93574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx cath slct p angrph mapca","code_information":[{"code":"93575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq transcath closure each","code_information":[{"code":"93592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Car outp meas drg cath chd","code_information":[{"code":"93598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Map tachycardia add-on","code_information":[{"code":"93609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrophys map 3d add-on","code_information":[{"code":"93613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Stimulation pacing heart","code_information":[{"code":"93623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Heart pacing mapping","code_information":[{"code":"93631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Evaluation heart device","code_information":[{"code":"93640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"N block inj common digit","code_information":[{"code":"64632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destroy c/th facet jnt addl","code_information":[{"code":"64634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Destroy l/s facet jnt addl","code_information":[{"code":"64636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodenerv 1 extrem 1-4 ea","code_information":[{"code":"64643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodenerv 1 extrem 5/> ea","code_information":[{"code":"64645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Chemodenerv eccrine glands","code_information":[{"code":"64653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Internal nerve revision","code_information":[{"code":"64727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Digit nerve surgery add-on","code_information":[{"code":"64778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Limb nerve surgery add-on","code_information":[{"code":"64783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Implant nerve end","code_information":[{"code":"64787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair nerve add-on","code_information":[{"code":"64832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair nerve add-on","code_information":[{"code":"64837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nerve surgery","code_information":[{"code":"64859","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Subsequent repair of nerve","code_information":[{"code":"64872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair & revise nerve add-on","code_information":[{"code":"64874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Repair nerve/shorten bone","code_information":[{"code":"64876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nerve graft add-on","code_information":[{"code":"64901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nerve graft add-on","code_information":[{"code":"64902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nrv rpr w/nrv algrft ea addl","code_information":[{"code":"64913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Nervous system surgery","code_information":[{"code":"64999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":2522.57,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Corneal smear","code_information":[{"code":"65430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna bx w/fluor gdn 1st les","code_information":[{"code":"10007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Fna bx w/ct gdn 1st les","code_information":[{"code":"10009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Fna bx w/mr gdn 1st les","code_information":[{"code":"10011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Guide cathet fluid drainage","code_information":[{"code":"10030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Perq dev soft tiss 1st imag","code_information":[{"code":"10035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Debride skin at fx site","code_information":[{"code":"11010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Debride skin musc at fx site","code_information":[{"code":"11011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Deb skin bone at fx site","code_information":[{"code":"11012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Deb bone 20 sq cm/<","code_information":[{"code":"11044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Incal bx skn single les","code_information":[{"code":"11106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc tr-ext b9+marg 0.5 cm<","code_information":[{"code":"11400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc tr-ext b9+marg 1.1-2 cm","code_information":[{"code":"11402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc tr-ext b9+marg 2.1-3cm/<","code_information":[{"code":"11403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.5/<","code_information":[{"code":"11420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.6-1","code_information":[{"code":"11421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 1.1-2","code_information":[{"code":"11422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face-mm b9+marg 0.5 cm/<","code_information":[{"code":"11440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face-mm b9+marg 0.6-1 cm","code_information":[{"code":"11441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face-mm b9+marg 1.1-2 cm","code_information":[{"code":"11442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face-mm b9+marg 2.1-3 cm","code_information":[{"code":"11443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face-mm b9+marg 3.1-4 cm","code_information":[{"code":"11444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc tr-ext mal+marg 0.5 cm/<","code_information":[{"code":"11600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc tr-ext mal+marg 0.6-1 cm","code_information":[{"code":"11601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Inj foramen epidural c/t","code_information":[{"code":"64479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Inj foramen epidural l/s","code_information":[{"code":"64483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Inj paravert f jnt c/t 1 lev","code_information":[{"code":"64490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Inj paravert f jnt l/s 1 lev","code_information":[{"code":"64493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block stellate ganglion","code_information":[{"code":"64510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj hypogas plxs","code_information":[{"code":"64517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block lumbar/thoracic","code_information":[{"code":"64520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj celiac pelus","code_information":[{"code":"64530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Chemodenerv 1 extremity 1-4","code_information":[{"code":"64642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Chemodenerv 1 extrem 5/> mus","code_information":[{"code":"64644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Chemodenerv trunk musc 1-5","code_information":[{"code":"64646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Chemodenerv trunk musc 6/>","code_information":[{"code":"64647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection treatment of nerve","code_information":[{"code":"64681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of cornea","code_information":[{"code":"65410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2598.71,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2547.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Trabeculoplasty laser surg","code_information":[{"code":"65855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Incise inner eye adhesions","code_information":[{"code":"65860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Revision of iris","code_information":[{"code":"66761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Revision of iris","code_information":[{"code":"66762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal of inner eye lesion","code_information":[{"code":"66770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"After cataract laser surgery","code_information":[{"code":"66821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Laser surgery eye strands","code_information":[{"code":"67031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Repair detached retina pc","code_information":[{"code":"67105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc tr-ext mal+marg 2.1-3 cm","code_information":[{"code":"11603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc tr-ext mal+marg 3.1-4 cm","code_information":[{"code":"11604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc h-f-nk-sp mal+marg 0.5/<","code_information":[{"code":"11620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 0.6-1","code_information":[{"code":"11621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 1.1-2","code_information":[{"code":"11622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 2.1-3","code_information":[{"code":"11623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.5cm<","code_information":[{"code":"11640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.6-1","code_information":[{"code":"11641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 1.1-2","code_information":[{"code":"11642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 2.1-3","code_information":[{"code":"11643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy nail unit","code_information":[{"code":"11755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Tx contour defects >10.0 cc","code_information":[{"code":"11954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove contraceptive capsule","code_information":[{"code":"11976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Intmd rpr n-hf/genit20.1-30","code_information":[{"code":"12046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Dermabrasion segmental face","code_information":[{"code":"15781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Dermabrasion other than face","code_information":[{"code":"15782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal of pressure sore","code_information":[{"code":"15999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drainage of breast lesion","code_information":[{"code":"19000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Perq device breast 1st imag","code_information":[{"code":"19281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Perq dev breast 1st strtctc","code_information":[{"code":"19283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Perq dev breast 1st us imag","code_information":[{"code":"19285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Perq dev breast 1st mr guide","code_information":[{"code":"19287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Explore wound extremity","code_information":[{"code":"20103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of bone cyst","code_information":[{"code":"20615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Application of head brace","code_information":[{"code":"20661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Comp ext fixate strut change","code_information":[{"code":"20697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Fluid pressure muscle","code_information":[{"code":"20950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face les sc <2 cm","code_information":[{"code":"21011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face les sbq 2 cm/>","code_information":[{"code":"21012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face tum deep < 2 cm","code_information":[{"code":"21013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exc face tum deep 2 cm/>","code_information":[{"code":"21014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove shoulder foreign body","code_information":[{"code":"23330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove shoulder fb deep","code_information":[{"code":"23333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat pelvic fracture(s)","code_information":[{"code":"27215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3576.46,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insertion of chest tube","code_information":[{"code":"32551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove lung catheter","code_information":[{"code":"32552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Aspirate pleura w/o imaging","code_information":[{"code":"32554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Aspirate pleura w/ imaging","code_information":[{"code":"32555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insert cath pleura w/ image","code_information":[{"code":"32557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat pleurodesis w/agent","code_information":[{"code":"32560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Lyse chest fibrin init day","code_information":[{"code":"32561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Lyse chest fibrin subq day","code_information":[{"code":"32562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Therapeutic pneumothorax","code_information":[{"code":"32960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Chest surgery procedure","code_information":[{"code":"32999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Pericardiocentesis w/imaging","code_information":[{"code":"33016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Rmvl subq car rhythm mntr","code_information":[{"code":"33286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cardiac surgery procedure","code_information":[{"code":"33999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Pseudoaneurysm injection trt","code_information":[{"code":"36002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insert picc cath","code_information":[{"code":"36568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ablate arrhythmia add on","code_information":[{"code":"93655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tx l/r atrial fib addl","code_information":[{"code":"93657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tilt table evaluation","code_information":[{"code":"93660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":399.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":403.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":407.88,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":399.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Intracardiac Ecg (Ice)","code_information":[{"code":"93662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Set-up cardiovert-defibrill","code_information":[{"code":"93745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":329.13,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.43,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.72,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329.13,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Interrogation vad in person","code_information":[{"code":"93750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.88,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":102.9,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.92,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cardiovascular procedure","code_information":[{"code":"93799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":353.96,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":357.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":361.04,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":353.96,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.94,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332.22,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":335.51,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":328.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Photodynamic tx skin","code_information":[{"code":"96567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Photodynmc tx 30 min add-on","code_information":[{"code":"96570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Photodynamic tx addl 15 min","code_information":[{"code":"96571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Pdt dstr prmlg les phys/qhp","code_information":[{"code":"96573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dbrdmt prmlg les w/pdt","code_information":[{"code":"96574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl devital tis 20 cm/<","code_information":[{"code":"97597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl devital tis addl 20cm/<","code_information":[{"code":"97598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bone srgry cmptr fluor image","code_information":[{"code":"0054T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Bone srgry cmptr ct/mri imag","code_information":[{"code":"0055T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove Lumb Artif Disc Addl","code_information":[{"code":"0164T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Revise Lumb Artif Disc Addl","code_information":[{"code":"0165T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Clear eyelid gland w/heat","code_information":[{"code":"0207T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.58,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":142.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx paravert w/us cer/thor","code_information":[{"code":"0214T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx paravert w/us cer/thor","code_information":[{"code":"0215T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx paravert w/us lumb/sac","code_information":[{"code":"0217T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx paravert w/us lumb/sac","code_information":[{"code":"0218T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Plmt post facet implt addl","code_information":[{"code":"0222T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx platelet plasma","code_information":[{"code":"0232T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Tempr","code_information":[{"code":"0278T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ins bone device for rsa","code_information":[{"code":"0347T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Ercp w/optical endomicroscpy","code_information":[{"code":"0397T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dstrj neurofibroma xtnsv","code_information":[{"code":"0419T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Dstrj neurofibroma xtnsv","code_information":[{"code":"0420T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Impltj synth rnfcmt abdl wal","code_information":[{"code":"0437T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"R-t spctrl alys prst8 tiss","code_information":[{"code":"0443T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"1st plmt drug elut oc ins","code_information":[{"code":"0444T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Sbsqt plmt drug elut oc ins","code_information":[{"code":"0445T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj impltbl glucose sensor","code_information":[{"code":"0446T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":4547.52,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4458.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rmvl impltbl glucose sensor","code_information":[{"code":"0447T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":215.00,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remvl insj impltbl gluc sens","code_information":[{"code":"0448T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":4547.52,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4458.35,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insj aqueous drain dev each","code_information":[{"code":"0450T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Supchrdl njx rxw/o supply","code_information":[{"code":"0465T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fxjl abl lsr ea addl 100sqcm","code_information":[{"code":"0480T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Njx autol wbc concentrate","code_information":[{"code":"0481T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"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":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Esw integ wnd hlg ea addl","code_information":[{"code":"0513T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"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":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"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":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"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":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Autol cell implt adps njx","code_information":[{"code":"0566T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq njx algc fluor lmbr ea","code_information":[{"code":"0628T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq njx algc ct lmbr ea","code_information":[{"code":"0630T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perq trluml coronry lithotrp","code_information":[{"code":"0715T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Car acous wavfrm rec cad rsk","code_information":[{"code":"0716T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prq elc nrv stim cn wo implt","code_information":[{"code":"0720T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Prep tum cav iort prim crnot","code_information":[{"code":"0735T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Colonic lavage 35+l water","code_information":[{"code":"0736T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.89,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":137.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perc drug-el cor stent bran","code_information":[{"code":"C9601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perc d-e cor stent ather br","code_information":[{"code":"C9603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perc d-e cor revasc t cabg b","code_information":[{"code":"C9605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Perc d-e cor revasc chro add","code_information":[{"code":"C9608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Rxt breast appl place/remov","code_information":[{"code":"C9726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Blue light cysto imag agent","code_information":[{"code":"C9738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fluorescence lymph map w/ICG","code_information":[{"code":"C9756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Transcath intraop microinf","code_information":[{"code":"C9759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Trim nail(s)","code_information":[{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.22,"maximum":1586.0,"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":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63.22,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Wound closure by adhesive","code_information":[{"code":"G0168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Inject for sacroiliac joint","code_information":[{"code":"G0259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Removal of impacted wax md","code_information":[{"code":"G0268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Occlusive device in vein art","code_information":[{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Arthro, loose body + chondro","code_information":[{"code":"G0289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Cont intraop neuro monitor","code_information":[{"code":"G0453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":693.0,"maximum":1586.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Insert drug del implant, >4","code_information":[{"code":"G0516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove drug implant","code_information":[{"code":"G0517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Remove w insert drug implant","code_information":[{"code":"G0518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.72,"maximum":1586.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":483.51,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":488.29,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1586.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":478.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":693.0}]}]},{"description":"Fna bx w/us gdn 1st les","code_information":[{"code":"10005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Dx lmbr spi pnxr w/fluor/ct","code_information":[{"code":"62328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ther spi pnxr csf fluor/ct","code_information":[{"code":"62329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj brachial plexus","code_information":[{"code":"64415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block cont infuse b plex","code_information":[{"code":"64416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj axillary","code_information":[{"code":"64417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj suprascapular","code_information":[{"code":"64418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj intercost sng","code_information":[{"code":"64420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj intercost mlt","code_information":[{"code":"64421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj ilio-ing/hypogi","code_information":[{"code":"64425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj pudendal","code_information":[{"code":"64430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj paracervical","code_information":[{"code":"64435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj sciatic sng","code_information":[{"code":"64445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N blk inj sciatic cont inf","code_information":[{"code":"64446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj fem single","code_information":[{"code":"64447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj fem cont inf","code_information":[{"code":"64448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block inj lumbar plexus","code_information":[{"code":"64449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"N block other peripheral","code_information":[{"code":"64450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx aa&/strd nrv nrvtg si jt","code_information":[{"code":"64451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx aa&/strd gnclr nrv brnch","code_information":[{"code":"64454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Pvb thoracic single inj site","code_information":[{"code":"64461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Pvb thoracic cont infusion","code_information":[{"code":"64463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of retina","code_information":[{"code":"67145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of retinal lesion","code_information":[{"code":"67210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of choroid lesion","code_information":[{"code":"67220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ocular Photodynamic Ther","code_information":[{"code":"67221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment x10sv retinopathy","code_information":[{"code":"67228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Tr retinal les preterm inf","code_information":[{"code":"67229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of eyelid lining","code_information":[{"code":"68100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2598.71,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2547.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Incise/drain tear sac","code_information":[{"code":"68420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2598.71,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2547.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Close tear system fistula","code_information":[{"code":"68770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2573.23,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2598.71,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2547.76,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drain outer ear canal lesion","code_information":[{"code":"69020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Temporary external pacing","code_information":[{"code":"92953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.28,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":715.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":722.45,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cardioversion electric ext","code_information":[{"code":"92960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.28,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":715.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":722.45,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cardioversion electric int","code_information":[{"code":"92961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":708.28,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":715.36,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":722.45,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":708.28,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insert/place heart catheter","code_information":[{"code":"93503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx paravert w/us cer/thor","code_information":[{"code":"0213T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx paravert w/us lumb/sac","code_information":[{"code":"0216T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Repos car modulj tranvns elt","code_information":[{"code":"0415T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Fxjl abl lsr 1st 100 sq cm","code_information":[{"code":"0479T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Perq impltj/rplcmt isdns ptn","code_information":[{"code":"0587T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":6966.01,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.42,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"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":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Temp fml iu valve-pmp rplcmt","code_information":[{"code":"0597T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Place endorectal app","code_information":[{"code":"C9725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"CA screen;flexi sigmoidscope","code_information":[{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Colorectal scrn; hi risk ind","code_information":[{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Colon ca scrn not hi rsk ind","code_information":[{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Dstry eye lesn,fdr vssl tech","code_information":[{"code":"G0186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":589.39,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":595.28,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":601.18,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":589.39,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Inj for sacroiliac jt anesth","code_information":[{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove foreign body","code_information":[{"code":"10121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of hematoma/fluid","code_information":[{"code":"10140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc tr-ext b9+marg 3.1-4 cm","code_information":[{"code":"11404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc tr-ext b9+marg >4.0 cm","code_information":[{"code":"11406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 2.1-3","code_information":[{"code":"11423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc h-f-nk-sp b9+marg 3.1-4","code_information":[{"code":"11424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc tr-ext mal+marg >4 cm","code_information":[{"code":"11606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg 3.1-4","code_information":[{"code":"11624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg 3.1-4","code_information":[{"code":"11644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Reconstruction of nail bed","code_information":[{"code":"11762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intmd rpr s/tr/ext >30.0 cm","code_information":[{"code":"12037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intmd rpr n-hf/genit >30.0cm","code_information":[{"code":"12047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Late closure of wound","code_information":[{"code":"13160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3797.52,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3797.52,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr trunk 10 sq cm/<","code_information":[{"code":"14000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr trunk 10.1-30sqcm","code_information":[{"code":"14001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr s/a/l 10 sq cm/<","code_information":[{"code":"14020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr s/a/l 10.1-30 sqcm","code_information":[{"code":"14021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr f/c/c/m/n/a/g/h/f","code_information":[{"code":"14041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr e/n/e/l 10 sq cm/<","code_information":[{"code":"14060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tis trnfr e/n/e/l10.1-30sqcm","code_information":[{"code":"14061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Filleted finger/toe flap","code_information":[{"code":"14350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Wound prep trk/arm/leg","code_information":[{"code":"15002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Harvest cultured skin graft","code_information":[{"code":"15040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skin splt grft trnk/arm/leg","code_information":[{"code":"15100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Epidrm autogrft trnk/arm/leg","code_information":[{"code":"15110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Epidrm a-grft face/nck/hf/g","code_information":[{"code":"15115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cult skin grft t/arm/leg","code_information":[{"code":"15150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skin full graft sclp/arm/leg","code_information":[{"code":"15220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skin full grft face/genit/hf","code_information":[{"code":"15240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skin full graft een & lips","code_information":[{"code":"15260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skin sub graft trnk/arm/leg","code_information":[{"code":"15271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skin sub graft face/nk/hf/g","code_information":[{"code":"15275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.00,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":799.92,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":807.84,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":792.0,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skn sub grft f/n/hf/g child","code_information":[{"code":"15277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Skin pedicle flap trunk","code_information":[{"code":"15570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Pedcle fh/ch/ch/m/n/ax/g/h/f","code_information":[{"code":"15574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Pedicle e/n/e/l/ntroral","code_information":[{"code":"15576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Delay flap f/c/c/n/ax/g/h/f","code_information":[{"code":"15620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Delay flap eye/nos/ear/lip","code_information":[{"code":"15630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Transfer skin pedicle flap","code_information":[{"code":"15650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Muscle-skin graft arm","code_information":[{"code":"15736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Island pedicle flap graft","code_information":[{"code":"15740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Composite skin graft","code_information":[{"code":"15760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Grfg autol fat lipo 25 cc/<","code_information":[{"code":"15773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Plastic surgery neck","code_information":[{"code":"15819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revision of lower eyelid","code_information":[{"code":"15821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revision of upper eyelid","code_information":[{"code":"15823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of forehead wrinkles","code_information":[{"code":"15824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excise excessive skin arm","code_information":[{"code":"15836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excise excess skin arm/hand","code_information":[{"code":"15837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excise excess skin fat pad","code_information":[{"code":"15838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insert picc cath","code_information":[{"code":"36569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insj picc rs&i <5 yr","code_information":[{"code":"36572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Replace cvad cath","code_information":[{"code":"36580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Replace picc cath","code_information":[{"code":"36584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Reposition venous catheter","code_information":[{"code":"36597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"External cannula declotting","code_information":[{"code":"36860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Thromblytic art/ven therapy","code_information":[{"code":"37213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cessj therapy cath removal","code_information":[{"code":"37214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Vascular endoscopy procedure","code_information":[{"code":"37501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ligation of neck vein","code_information":[{"code":"37565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ligate leg veins open","code_information":[{"code":"37761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Revision of leg vein","code_information":[{"code":"37780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3451.29,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3383.62,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Vascular surgery procedure","code_information":[{"code":"37799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":672.23,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":678.95,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":685.67,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":672.23,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Bone marrow aspiration","code_information":[{"code":"38220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Bone marrow biopsy","code_information":[{"code":"38221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of floor of mouth","code_information":[{"code":"41108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of throat","code_information":[{"code":"42800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Proctosigmoidoscopy dx","code_information":[{"code":"45300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Diagnostic sigmoidoscopy","code_information":[{"code":"45330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Sigmoidoscopy and biopsy","code_information":[{"code":"45331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Sigmoidoscopy & polypectomy","code_information":[{"code":"45333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Sigmoidoscopy w/submuc inj","code_information":[{"code":"45335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of rectal prolapse","code_information":[{"code":"45520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Reduction of rectal prolapse","code_information":[{"code":"45900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Rectum surgery procedure","code_information":[{"code":"45999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Incision of anal abscess","code_information":[{"code":"46050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ligation of hemorrhoid(s)","code_information":[{"code":"46221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection into hemorrhoid(s)","code_information":[{"code":"46500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Destroy internal hemorrhoids","code_information":[{"code":"46930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Anus surgery procedure","code_information":[{"code":"46999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Liver surgery procedure","code_information":[{"code":"47399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Bile duct endoscopy add-on","code_information":[{"code":"47550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Pancreas surgery procedure","code_information":[{"code":"48999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Sclerotx fluid collection","code_information":[{"code":"49185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove renal tube w/fluoro","code_information":[{"code":"50389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drainage of kidney lesion","code_information":[{"code":"50390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Measure kidney pressure","code_information":[{"code":"50396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx px nfrosgrm &/urtrgrm","code_information":[{"code":"50431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Convert nephrostomy catheter","code_information":[{"code":"50434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exchange nephrostomy cath","code_information":[{"code":"50435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Close kidney-skin fistula","code_information":[{"code":"50520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Renal scope w/tumor resect","code_information":[{"code":"50562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":10347.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10245.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.33,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ureter endoscopy","code_information":[{"code":"50970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Ureter endoscopy & catheter","code_information":[{"code":"50972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3852.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Incise bladder/drain ureter","code_information":[{"code":"51045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Change of bladder tube","code_information":[{"code":"51710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cystometrogram w/up","code_information":[{"code":"51727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cystometrogram w/vp","code_information":[{"code":"51728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cystometrogram w/vp&up","code_information":[{"code":"51729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cystoscopy","code_information":[{"code":"52000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cystoscopy & duct catheter","code_information":[{"code":"52010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remov/replc ur sphinctr comp","code_information":[{"code":"53448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insert prost urethral stent","code_information":[{"code":"53855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remv/replc penis pros compl","code_information":[{"code":"54417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":22654.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22432.6,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22654.71,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22210.5,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of epididymis","code_information":[{"code":"54800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":3176.0,"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":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drainage of hydrocele","code_information":[{"code":"55000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Incise sperm duct pouch","code_information":[{"code":"55605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove sperm duct pouch","code_information":[{"code":"55650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":3176.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Electroejaculation","code_information":[{"code":"55870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of vulva/perineum","code_information":[{"code":"56605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of vagina","code_information":[{"code":"57100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Insert uteri tandem/ovoids","code_information":[{"code":"57155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1963.0,"maximum":5467.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5414.33,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5467.93,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5360.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Exam/biopsy of vag w/scope","code_information":[{"code":"57421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Biopsy of cervix","code_information":[{"code":"57500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Endocervical curettage","code_information":[{"code":"57505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Retrieval of oocyte","code_information":[{"code":"58970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Transfer of embryo","code_information":[{"code":"58974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Amniocentesis diagnostic","code_information":[{"code":"59000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Chorion biopsy","code_information":[{"code":"59015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":987.01,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.89,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.76,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":987.01,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Excise excess skin & tissue","code_information":[{"code":"15839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Nerve palsy microsurg graft","code_information":[{"code":"15842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove sutures diff surgeon","code_information":[{"code":"15851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Suction lipectomy upr extrem","code_information":[{"code":"15878","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Escharotomy addl incision","code_information":[{"code":"16036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bx breast 1st lesion strtctc","code_information":[{"code":"19081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bx breast 1st lesion us imag","code_information":[{"code":"19083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bx breast 1st lesion mr imag","code_information":[{"code":"19085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bx breast percut w/o image","code_information":[{"code":"19100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Explore wound chest","code_information":[{"code":"20101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Explore wound abdomen","code_information":[{"code":"20102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Muscle biopsy","code_information":[{"code":"20200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Deep muscle biopsy","code_information":[{"code":"20205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Needle biopsy muscle","code_information":[{"code":"20206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Injection of sinus tract","code_information":[{"code":"20500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Apply rem fixation device","code_information":[{"code":"20660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Application of halo","code_information":[{"code":"20664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of support implant","code_information":[{"code":"20670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove bone fixation device","code_information":[{"code":"20694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of thyroid","code_information":[{"code":"60100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Aspir/inj thyroid cyst","code_information":[{"code":"60300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Remove brain cavity fluid","code_information":[{"code":"61020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Brain canal shunt procedure","code_information":[{"code":"61070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Epidural lysis mult sessions","code_information":[{"code":"62263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Epidural lysis on single day","code_information":[{"code":"62264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Interdiscal perq aspir dx","code_information":[{"code":"62267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":758.85,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":766.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":774.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":758.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drain spinal cord cyst","code_information":[{"code":"62268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Spinal fluid tap diagnostic","code_information":[{"code":"62270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Drain cerebro spinal fluid","code_information":[{"code":"62272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Inject epidural patch","code_information":[{"code":"62273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat spinal cord lesion","code_information":[{"code":"62281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Treat spinal canal lesion","code_information":[{"code":"62282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Injection into spinal artery","code_information":[{"code":"62294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.06,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":848.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":856.87,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.06,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":848.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":856.87,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.06,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":848.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":856.87,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Myelography lumbar injection","code_information":[{"code":"62305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":840.06,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":848.46,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":856.87,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":840.06,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":756.44,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":764.0,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":771.56,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":756.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":947.82,"maximum":3176.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":957.3,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":966.77,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3176.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":947.82,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1963.0}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Release palm contracture","code_information":[{"code":"26040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incise finger tendon sheath","code_information":[{"code":"26055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Explore/treat hand joint","code_information":[{"code":"26070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy hand joint lining","code_information":[{"code":"26100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc hand les sc < 1.5 cm","code_information":[{"code":"26115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc hand tum deep < 1.5 cm","code_information":[{"code":"26116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Rad resect hand tumor < 3 cm","code_information":[{"code":"26117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"26130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tendon excision palm/finger","code_information":[{"code":"26145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove tendon sheath lesion","code_information":[{"code":"26160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of palm tendon each","code_information":[{"code":"26170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of finger tendon","code_information":[{"code":"26180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove finger bone","code_information":[{"code":"26185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove hand bone lesion","code_information":[{"code":"26200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of finger lesion","code_information":[{"code":"26210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove/graft finger lesion","code_information":[{"code":"26215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Partial removal of hand bone","code_information":[{"code":"26230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Extensive hand surgery","code_information":[{"code":"26250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect prox finger tumor","code_information":[{"code":"26260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect distal finger tumor","code_information":[{"code":"26262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of implant from hand","code_information":[{"code":"26320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair hand tendon","code_information":[{"code":"26410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Realignment of tendons","code_information":[{"code":"26437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Release palm/finger tendon","code_information":[{"code":"26440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Release hand/finger tendon","code_information":[{"code":"26445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of palm tendon","code_information":[{"code":"26450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incise hand/finger tendon","code_information":[{"code":"26460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tendon lengthening","code_information":[{"code":"26476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tendon shortening","code_information":[{"code":"26477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Lengthening of hand tendon","code_information":[{"code":"26478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Shortening of hand tendon","code_information":[{"code":"26479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":7931.41,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Release thumb contracture","code_information":[{"code":"26508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Release knuckle contracture","code_information":[{"code":"26520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Release finger contracture","code_information":[{"code":"26525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair hand joint","code_information":[{"code":"26540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair of web finger","code_information":[{"code":"26560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair hand deformity","code_information":[{"code":"26580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Reconstruct extra finger","code_information":[{"code":"26587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair finger deformity","code_information":[{"code":"26590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Release muscles of hand","code_information":[{"code":"26593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision constricting tissue","code_information":[{"code":"26596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Pin knuckle dislocation","code_information":[{"code":"26706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc hip/pelvis les sc < 3 cm","code_information":[{"code":"27047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc hip/pelv tum deep < 5 cm","code_information":[{"code":"27048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect hip/pelv tum < 5 cm","code_information":[{"code":"27049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat pelvic ring fracture","code_information":[{"code":"27218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cltx thigh fx","code_information":[{"code":"27267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Optx thigh fx","code_information":[{"code":"27269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":7931.41,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Manipulation of hip joint","code_information":[{"code":"27275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Neurectomy hamstring","code_information":[{"code":"27325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Neurectomy popliteal","code_information":[{"code":"27326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc thigh/knee tum deep <5cm","code_information":[{"code":"27328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect thigh/knee tum < 5 cm","code_information":[{"code":"27329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Fixation of knee joint","code_information":[{"code":"27570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect leg/ankle tum < 5 cm","code_information":[{"code":"27615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc leg/ankle tum < 3 cm","code_information":[{"code":"27618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc leg/ankle tum deep <5 cm","code_information":[{"code":"27619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cltx med ankle fx w/mnpj","code_information":[{"code":"27762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Fixation of ankle joint","code_information":[{"code":"27860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of bursa of foot","code_information":[{"code":"28001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc foot/toe tum sc < 1.5 cm","code_information":[{"code":"28043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc foot/toe tum deep <1.5cm","code_information":[{"code":"28045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect foot/toe tumor < 3 cm","code_information":[{"code":"28046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intranasal biopsy","code_information":[{"code":"30100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of nose lesion","code_information":[{"code":"30124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Nasal sinus therapy","code_information":[{"code":"30210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insert nasal septal button","code_information":[{"code":"30220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ablate inf turbinate superf","code_information":[{"code":"30801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ablate inf turbinate submuc","code_information":[{"code":"30802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Irrigation sphenoid sinus","code_information":[{"code":"31002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx laryngoscopy excl nb","code_information":[{"code":"31525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx laryngoscopy w/oper scope","code_information":[{"code":"31526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Laryngoscopy w/fb removal","code_information":[{"code":"31530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Laryngoscopy w/fb & op scope","code_information":[{"code":"31531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Laryngoscope w/vc inj","code_information":[{"code":"31570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Largsc w/ther injection","code_information":[{"code":"31573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Largsc w/njx augmentation","code_information":[{"code":"31574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Largsc w/removal lesion","code_information":[{"code":"31578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx bronchoscope/wash","code_information":[{"code":"31622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx bronchoscope/brush","code_information":[{"code":"31623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx bronchoscope/lavage","code_information":[{"code":"31624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bronchoscopy w/biopsy(s)","code_information":[{"code":"31625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bronchoscopy/lung bx each","code_information":[{"code":"31628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bronchoscopy w/fb removal","code_information":[{"code":"31635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Diag bronchoscope/catheter","code_information":[{"code":"31643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bronchoscopy clear airways","code_information":[{"code":"31645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bronchial valve remov addl","code_information":[{"code":"31649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intro windpipe wire/tube","code_information":[{"code":"31730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair of windpipe injury","code_information":[{"code":"31800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Needle biopsy chest lining","code_information":[{"code":"32400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Core ndl bx lng/med perq","code_information":[{"code":"32408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ins mark thor for rt perq","code_information":[{"code":"32553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.26,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1498.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1512.93,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1483.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insert cath pleura w/o image","code_information":[{"code":"32556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Total lung lavage","code_information":[{"code":"32997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Relocation pocket pacemaker","code_information":[{"code":"33222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Relocate pocket for defib","code_information":[{"code":"33223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Njx noncmpnd sclrsnt 1 vein","code_information":[{"code":"36465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Njx noncmpnd sclrsnt mlt vn","code_information":[{"code":"36466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Apheresis wbc","code_information":[{"code":"36511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Apheresis rbc","code_information":[{"code":"36512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Apheresis plasma","code_information":[{"code":"36514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insj picc rs&i 5 yr+","code_information":[{"code":"36573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1686.89,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1703.76,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1720.63,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1686.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Temporal artery procedure","code_information":[{"code":"37609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Harvest auto stem cells","code_information":[{"code":"38206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx bone marrow bx & aspir","code_information":[{"code":"38222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bone marrow harvest allogen","code_information":[{"code":"38230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Transplt autol hct/donor","code_information":[{"code":"38241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Transplt allo lymphocytes","code_information":[{"code":"38242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Transplj hematopoietic boost","code_information":[{"code":"38243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1668.97,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1685.66,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1702.35,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1668.97,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect face/scalp tum < 2 cm","code_information":[{"code":"21015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Mnpj of tmj w/anesth","code_information":[{"code":"21073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Prepare face/oral prosthesis","code_information":[{"code":"21076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Interdental fixation","code_information":[{"code":"21110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ear cartilage graft","code_information":[{"code":"21235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revision of eyelid","code_information":[{"code":"21282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closed tx nose fx w/o stablj","code_information":[{"code":"21315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closed tx nose fx w/ stablj","code_information":[{"code":"21320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closed tx septal&nose fx","code_information":[{"code":"21337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closed tx nose/jaw fx","code_information":[{"code":"21345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closed tx orbit w/manipulj","code_information":[{"code":"21401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Reset dislocated jaw","code_information":[{"code":"21485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Interdental wiring","code_information":[{"code":"21497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of neck/chest","code_information":[{"code":"21550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc neck les sc < 3 cm","code_information":[{"code":"21555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect neck thorax tumor<5cm","code_information":[{"code":"21557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc back les sc < 3 cm","code_information":[{"code":"21930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc back tum deep < 5 cm","code_information":[{"code":"21932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect back tum < 5 cm","code_information":[{"code":"21935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closed tx vert fx w/manj","code_information":[{"code":"22315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Manipulation of spine","code_information":[{"code":"22505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc abd les sc < 3 cm","code_information":[{"code":"22902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Radical resect abd tumor<5cm","code_information":[{"code":"22904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of calcium deposits","code_information":[{"code":"23000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc shoulder les sc < 3 cm","code_information":[{"code":"23075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc shoulder tum deep < 5 cm","code_information":[{"code":"23076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect shoulder tumor < 5 cm","code_information":[{"code":"23077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Fixation of shoulder","code_information":[{"code":"23700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"23921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of arm bursa","code_information":[{"code":"23931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc arm/elbow les sc < 3 cm","code_information":[{"code":"24075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ex arm/elbow tum deep < 5 cm","code_information":[{"code":"24076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect arm/elbow tum < 5 cm","code_information":[{"code":"24077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Manipulate elbow w/anesth","code_information":[{"code":"24300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc forearm les sc < 3 cm","code_information":[{"code":"25075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exc forearm tum deep < 3 cm","code_information":[{"code":"25076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect forearm/wrist tum<3cm","code_information":[{"code":"25077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Manipulate wrist w/anesthes","code_information":[{"code":"25259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drain hand tendon sheath","code_information":[{"code":"26020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of palm bursa","code_information":[{"code":"26025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of palm bursas","code_information":[{"code":"26030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat hand bone lesion","code_information":[{"code":"26034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd remove foreign body","code_information":[{"code":"43247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd guide wire insertion","code_information":[{"code":"43248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esoph egd dilation <30 mm","code_information":[{"code":"43249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd cautery tumor polyp","code_information":[{"code":"43250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd remove lesion snare","code_information":[{"code":"43251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd optical endomicroscopy","code_information":[{"code":"43252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd us transmural injxn/mark","code_information":[{"code":"43253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd endo mucosal resection","code_information":[{"code":"43254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd control bleeding any","code_information":[{"code":"43255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd us exam duodenum/jejunum","code_information":[{"code":"43259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd lesion ablation","code_information":[{"code":"43270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd flx trnsorl dplmnt balo","code_information":[{"code":"43290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd flx trnsorl rmvl balo","code_information":[{"code":"43291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dilate esophagus 1/mult pass","code_information":[{"code":"43450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dilate esophagus","code_information":[{"code":"43453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagus surgery procedure","code_information":[{"code":"43499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Surgical opening of stomach","code_information":[{"code":"43510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx duod intub w/asp spec","code_information":[{"code":"43756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dx duod intub w/asp specs","code_information":[{"code":"43757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove gastric port open","code_information":[{"code":"43887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Stomach surgery procedure","code_information":[{"code":"43999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of bowel","code_information":[{"code":"44100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Open bowel to skin","code_information":[{"code":"44300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Endoscopy of bowel pouch","code_information":[{"code":"44385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Endoscopy bowel pouch/biop","code_information":[{"code":"44386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy thru stoma spx","code_information":[{"code":"44388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy with biopsy","code_information":[{"code":"44389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy for foreign body","code_information":[{"code":"44390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy for bleeding","code_information":[{"code":"44391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy & polypectomy","code_information":[{"code":"44392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/snare","code_information":[{"code":"44394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy with ablation","code_information":[{"code":"44401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/stent plcmt","code_information":[{"code":"44402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":6635.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.8,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"44403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/injection","code_information":[{"code":"44404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/dilation","code_information":[{"code":"44405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/ultrasound","code_information":[{"code":"44406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/ndl aspir/bx","code_information":[{"code":"44407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"44408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intro gastrointestinal tube","code_information":[{"code":"44500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Unlisted px small intestine","code_information":[{"code":"44799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"45000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of rectum","code_information":[{"code":"45100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of rectal stricture","code_information":[{"code":"45150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Proctosigmoidoscopy dilate","code_information":[{"code":"45303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Proctosigmoidoscopy w/bx","code_information":[{"code":"45305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Proctosigmoidoscopy bleed","code_information":[{"code":"45317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy w/fb removal","code_information":[{"code":"45332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy for bleeding","code_information":[{"code":"45334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy & decompress","code_information":[{"code":"45337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy w/tumr remove","code_information":[{"code":"45338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sig w/tndsc balloon dilation","code_information":[{"code":"45340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy W/Ultrasound","code_information":[{"code":"45341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy W/Us Guide Bx","code_information":[{"code":"45342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy w/ablation","code_information":[{"code":"45346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sigmoidoscopy w/plcmt stent","code_information":[{"code":"45347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":6635.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.8,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Needle biopsy lymph nodes","code_information":[{"code":"38505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Partial excision of lip","code_information":[{"code":"40520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair lip","code_information":[{"code":"40654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of mouth lesion","code_information":[{"code":"40810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excise/repair mouth lesion","code_information":[{"code":"40812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excise lip or cheek fold","code_information":[{"code":"40819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treatment of mouth lesion","code_information":[{"code":"40820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of tongue fold","code_information":[{"code":"41010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"41018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of tongue","code_information":[{"code":"41105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of tongue lesion","code_information":[{"code":"41113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of tongue fold","code_information":[{"code":"41115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tongue to lip surgery","code_information":[{"code":"41510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal foreign body gum","code_information":[{"code":"41805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal foreign body jawbone","code_information":[{"code":"41806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of gum flap","code_information":[{"code":"41821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of gum lesion","code_information":[{"code":"41828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treatment of gum lesion","code_information":[{"code":"41850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Gum graft","code_information":[{"code":"41870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair tooth socket","code_information":[{"code":"41874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy roof of mouth","code_information":[{"code":"42100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision lesion mouth roof","code_information":[{"code":"42106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of uvula","code_information":[{"code":"42140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treatment mouth roof lesion","code_information":[{"code":"42160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insertion palate prosthesis","code_information":[{"code":"42281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of salivary gland","code_information":[{"code":"42300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of salivary stone","code_information":[{"code":"42340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closure of salivary fistula","code_information":[{"code":"42600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dilation of salivary duct","code_information":[{"code":"42650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of throat abscess","code_information":[{"code":"42720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of upper nose/throat","code_information":[{"code":"42804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair throat wound","code_information":[{"code":"42900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Surgical opening of throat","code_information":[{"code":"42955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Control nose/throat bleeding","code_information":[{"code":"42972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of esophagus","code_information":[{"code":"43020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy rigid trnso dx","code_information":[{"code":"43191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscp rig trnso inject","code_information":[{"code":"43192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscp rig trnso biopsy","code_information":[{"code":"43193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscp rig trnso rem fb","code_information":[{"code":"43194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy rigid balloon","code_information":[{"code":"43195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4131.60,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4131.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscp guide wire dilat","code_information":[{"code":"43196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy flex dx brush","code_information":[{"code":"43197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagosc flex trnsn biopsy","code_information":[{"code":"43198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy flexible brush","code_information":[{"code":"43200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esoph scope w/submucous inj","code_information":[{"code":"43201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy flex biopsy","code_information":[{"code":"43202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esoph scope w/sclerosis inj","code_information":[{"code":"43204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagus endoscopy/ligation","code_information":[{"code":"43205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esoph optical endomicroscopy","code_information":[{"code":"43206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscop mucosal resect","code_information":[{"code":"43211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy retro balloon","code_information":[{"code":"43213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagosc dilate balloon 30","code_information":[{"code":"43214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy flex remove fb","code_information":[{"code":"43215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy snare les remv","code_information":[{"code":"43217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy balloon <30mm","code_information":[{"code":"43220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esoph endoscopy dilation","code_information":[{"code":"43226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy control bleed","code_information":[{"code":"43227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscop ultrasound exam","code_information":[{"code":"43231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophagoscopy w/us needle bx","code_information":[{"code":"43232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd balloon dil esoph30 mm/>","code_information":[{"code":"43233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd diagnostic brush wash","code_information":[{"code":"43235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Uppr gi scope w/submuc inj","code_information":[{"code":"43236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Endoscopic us exam esoph","code_information":[{"code":"43237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd biopsy single/multiple","code_information":[{"code":"43239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd tube/cath insertion","code_information":[{"code":"43241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd injection varices","code_information":[{"code":"43243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd varices ligation","code_information":[{"code":"43244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd dilate stricture","code_information":[{"code":"43245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd place gastrostomy tube","code_information":[{"code":"43246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Extraction of lens","code_information":[{"code":"66940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Eye surgery procedure","code_information":[{"code":"66999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Eye surgery procedure","code_information":[{"code":"67299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of eyelid","code_information":[{"code":"67710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove eyelid lesions","code_information":[{"code":"67801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove eyelid lesion","code_information":[{"code":"67840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treat eyelid lesion","code_information":[{"code":"67850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Closure of eyelid by suture","code_information":[{"code":"67875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incise/drain eyelid lining","code_information":[{"code":"68020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incise/drain tear gland","code_information":[{"code":"68400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of external ear canal","code_information":[{"code":"69105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove external ear partial","code_information":[{"code":"69110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of eardrum","code_information":[{"code":"69421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Create eardrum opening","code_information":[{"code":"69436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove ear lesion","code_information":[{"code":"69540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Close mastoid fistula","code_information":[{"code":"69700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incise inner ear","code_information":[{"code":"69801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Gi tract capsule endoscopy","code_information":[{"code":"91110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophageal Capsule Endoscopy","code_information":[{"code":"91111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Gi wireless capsule measure","code_information":[{"code":"91112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bundle of His recording","code_information":[{"code":"93600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":8525.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intra-atrial recording","code_information":[{"code":"93602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":8525.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Right ventricular recording","code_information":[{"code":"93603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1304.74,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.83,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1304.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intra-atrial pacing","code_information":[{"code":"93610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":8525.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Intraventricular pacing","code_information":[{"code":"93612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":8525.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8441.85,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8358.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophageal recording","code_information":[{"code":"93615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1304.74,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.83,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1304.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Esophageal recording","code_information":[{"code":"93616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1304.74,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.83,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1304.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Heart rhythm pacing","code_information":[{"code":"93618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1304.74,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.83,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1304.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Electrophysiology evaluation","code_information":[{"code":"93642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1304.74,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1317.78,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1330.83,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1304.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Reloc skin pocket pls gen","code_information":[{"code":"0416T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Tmpst auto tube dlvr sys","code_information":[{"code":"0583T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insj gtube perq mag gastrpxy","code_information":[{"code":"0647T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Mag ctrld capsule endoscopy","code_information":[{"code":"0651T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd flx transnasal dx br/wa","code_information":[{"code":"0652T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd flx transnasal bx 1/ml","code_information":[{"code":"0653T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Egd flx transnasal tube/cath","code_information":[{"code":"0654T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4131.60,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4131.6,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Abltj b9 thyr ndul perq lasr","code_information":[{"code":"0673T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Low cost skin substitute app","code_information":[{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insert palate implants","code_information":[{"code":"C9727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Complex drainage wound","code_information":[{"code":"10180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc h-f-nk-sp b9+marg >4 cm","code_information":[{"code":"11426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc face-mm b9+marg >4 cm","code_information":[{"code":"11446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc s/n/h/f/g mal+mrg >4 cm","code_information":[{"code":"11626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc f/e/e/n/l mal+mrg >4 cm","code_information":[{"code":"11646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove pilonidal cyst simple","code_information":[{"code":"11770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove pilonidal cyst exten","code_information":[{"code":"11771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove pilonidal cyst compl","code_information":[{"code":"11772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove tissue expander(s)","code_information":[{"code":"11971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Derm autograft trnk/arm/leg","code_information":[{"code":"15130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Skin full graft trunk","code_information":[{"code":"15200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Delay flap arms/legs","code_information":[{"code":"15610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Free myo/skin flap microvasc","code_information":[{"code":"15756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":5672.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Free skin flap microvasc","code_information":[{"code":"15757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":5672.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Free fascial flap microvasc","code_information":[{"code":"15758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":5672.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Dermabrasion total face","code_information":[{"code":"15780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise excessive skin thigh","code_information":[{"code":"15832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise excessive skin leg","code_information":[{"code":"15833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise excessive skin hip","code_information":[{"code":"15834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise excessive skin buttck","code_information":[{"code":"15835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of breast lesion","code_information":[{"code":"19020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Sigmoidoscopy w/resection","code_information":[{"code":"45349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sgmdsc w/band ligation","code_information":[{"code":"45350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Diagnostic colonoscopy","code_information":[{"code":"45378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/fb removal","code_information":[{"code":"45379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy and biopsy","code_information":[{"code":"45380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy submucous njx","code_information":[{"code":"45381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/control bleed","code_information":[{"code":"45382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/balloon dilat","code_information":[{"code":"45386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/ablation","code_information":[{"code":"45388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/stent plcmt","code_information":[{"code":"45389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":6635.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6570.74,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6635.8,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.69,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"45390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/endoscope us","code_information":[{"code":"45391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/endoscopic fnb","code_information":[{"code":"45392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"45393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Colonoscopy w/band ligation","code_information":[{"code":"45398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Unlisted procedure colon","code_information":[{"code":"45399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dilation of anal sphincter","code_information":[{"code":"45905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dilation of rectal narrowing","code_information":[{"code":"45910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove rectal obstruction","code_information":[{"code":"45915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Surg dx exam anorectal","code_information":[{"code":"45990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of rectal marker","code_information":[{"code":"46030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of anal septum","code_information":[{"code":"46070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of anal sphincter","code_information":[{"code":"46080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excise anal ext tag/papilla","code_information":[{"code":"46220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of anal tags","code_information":[{"code":"46230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of hemorrhoid clot","code_information":[{"code":"46320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Chemodenervation anal musc","code_information":[{"code":"46505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Anoscopy and dilation","code_information":[{"code":"46604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Anoscopy and biopsy","code_information":[{"code":"46606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Diagnostic anoscopy & biopsy","code_information":[{"code":"46607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Anoscopy remove for body","code_information":[{"code":"46608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Anoscopy","code_information":[{"code":"46611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":996.56,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1006.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1016.49,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":996.56,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Anoscopy control bleeding","code_information":[{"code":"46614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of suture from anus","code_information":[{"code":"46754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2974.45,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3004.19,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3033.94,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2974.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Needle biopsy of liver","code_information":[{"code":"47000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Inject/aspirate liver cyst","code_information":[{"code":"47015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal biliary drg cath","code_information":[{"code":"47537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Bile tract surgery procedure","code_information":[{"code":"47999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Needle biopsy pancreas","code_information":[{"code":"48102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Abd paracentesis","code_information":[{"code":"49082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Abd paracentesis w/imaging","code_information":[{"code":"49083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Peritoneal lavage","code_information":[{"code":"49084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy abdominal mass","code_information":[{"code":"49180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Image cath fluid colxn visc","code_information":[{"code":"49405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Image cath fluid peri/retro","code_information":[{"code":"49406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Image cath fluid trns/vgnl","code_information":[{"code":"49407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ins mark abd/pel for rt perq","code_information":[{"code":"49411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.26,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1498.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1512.93,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1483.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Exchange drainage catheter","code_information":[{"code":"49423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insert abdomen-venous drain","code_information":[{"code":"49425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ligation of shunt","code_information":[{"code":"49428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Insert Subq Exten to IP Cath","code_information":[{"code":"49435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Embedded IP Cath Exit-Site","code_information":[{"code":"49436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Place gastrostomy tube perc","code_information":[{"code":"49440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Place duod/jej tube perc","code_information":[{"code":"49441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Place cecostomy tube perc","code_information":[{"code":"49442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.34,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1295.17,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1307.99,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1282.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Change g-tube to g-j perc","code_information":[{"code":"49446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2056.34,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2056.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Replace g/c tube perc","code_information":[{"code":"49450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Replace duod/jej tube perc","code_information":[{"code":"49451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Replace g-j tube perc","code_information":[{"code":"49452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Fix g/colon tube w/device","code_information":[{"code":"49460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"49999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":971.94,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":971.94,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Renal biopsy perq","code_information":[{"code":"50200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Change nephroureteral cath","code_information":[{"code":"50387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Kidney endoscopy","code_information":[{"code":"50551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5860.72,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Kidney endoscopy & biopsy","code_information":[{"code":"50555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":10347.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10245.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.33,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":10347.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10245.88,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10347.33,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Kidney endoscopy & treatment","code_information":[{"code":"50580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5860.72,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Change of ureter tube/stent","code_information":[{"code":"50688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Endoscopy of ureter","code_information":[{"code":"50953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.44,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ureter endoscopy & biopsy","code_information":[{"code":"50974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5860.72,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Ureter endoscopy & treatment","code_information":[{"code":"50976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5860.72,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5745.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of bladder abscess","code_information":[{"code":"51080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drain bladder by trocar/cath","code_information":[{"code":"51101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":920.24,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":929.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":938.65,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":920.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cystoscopy removal of clots","code_information":[{"code":"52001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.44,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cystoscopy & revise urethra","code_information":[{"code":"52270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.24,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":747.24,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cystoscopy chemodenervation","code_information":[{"code":"52287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cystoscopy and treatment","code_information":[{"code":"52310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.44,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Prostatic microwave thermotx","code_information":[{"code":"53850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.44,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Transurethral rf treatment","code_information":[{"code":"53860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2240.09,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2262.49,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2284.9,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2240.09,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drain penis lesion","code_information":[{"code":"54015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Laser surg penis lesion(s)","code_information":[{"code":"54057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Excision of penis lesion(s)","code_information":[{"code":"54060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of penis","code_information":[{"code":"54125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Dynamic cavernosometry","code_information":[{"code":"54231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":267.74,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":270.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":273.1,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":267.74,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drainage of scrotum abscess","code_information":[{"code":"55100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of prostate","code_information":[{"code":"55700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Biopsy of prostate","code_information":[{"code":"55705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.44,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Prostate saturation sampling","code_information":[{"code":"55706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3777.44,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3815.21,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3852.98,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3777.44,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Place rt device/marker pros","code_information":[{"code":"55876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1483.26,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1498.09,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1512.93,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1483.26,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Destroy vulva lesions sim","code_information":[{"code":"56501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Destroy vulva lesion/s compl","code_information":[{"code":"56515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"I & d vaginal hematoma pp","code_information":[{"code":"57022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Division of fallopian tube","code_information":[{"code":"58605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Abortion","code_information":[{"code":"59856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Drain thyroid/tongue cyst","code_information":[{"code":"60000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1662.71,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1662.71,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Implant brain electrodes","code_information":[{"code":"61531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Implant brain electrodes","code_information":[{"code":"61760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Srs cran les simple addl","code_information":[{"code":"61797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Srs cran les complex addl","code_information":[{"code":"61799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Replace/irrigate catheter","code_information":[{"code":"62225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3660.81,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3697.42,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3734.02,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3660.81,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove brain cavity shunt","code_information":[{"code":"62256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Needle biopsy spinal cord","code_information":[{"code":"62269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Stimulation of spinal cord","code_information":[{"code":"63610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Srs spinal lesion addl","code_information":[{"code":"63621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4157.0,"maximum":5339.0,"payers_information":[{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of brow nerve","code_information":[{"code":"64732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of cheek nerve","code_information":[{"code":"64734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of chin nerve","code_information":[{"code":"64736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of jaw nerve","code_information":[{"code":"64738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incise diaphragm nerve","code_information":[{"code":"64746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incise hip/thigh nerve","code_information":[{"code":"64763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Sympathectomy cervical","code_information":[{"code":"64802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2092.58,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2113.5,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2134.43,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2092.58,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Repair of eye wound","code_information":[{"code":"65286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of eye lesion","code_information":[{"code":"65400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Curette/treat cornea","code_information":[{"code":"65435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Correction of astigmatism","code_information":[{"code":"65772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Cover eye w/membrane","code_information":[{"code":"65778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1068.27,"maximum":5339.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1078.96,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1089.64,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1068.27,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Injection treatment of eye","code_information":[{"code":"66020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Injection treatment of eye","code_information":[{"code":"66030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Incision of iris","code_information":[{"code":"66505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of iris","code_information":[{"code":"66625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Removal of iris","code_information":[{"code":"66630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Destruction ciliary body","code_information":[{"code":"66700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2473.11,"maximum":5339.0,"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":5339.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2473.11,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4157.0}]}]},{"description":"Resect arm/elbow tum 5 cm/>","code_information":[{"code":"24079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputation of toe","code_information":[{"code":"28820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Partial amputation of toe","code_information":[{"code":"28825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Scope plantar fasciotomy","code_information":[{"code":"29893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of nose polyp(s)","code_information":[{"code":"30115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of intranasal lesion","code_information":[{"code":"30118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise inferior turbinate","code_information":[{"code":"30130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect inferior turbinate","code_information":[{"code":"30140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reconstruction of nose","code_information":[{"code":"30400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of nose","code_information":[{"code":"30430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of nasal septum","code_information":[{"code":"30520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair nasal septum defect","code_information":[{"code":"30630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Ther fx nasal inf turbinate","code_information":[{"code":"30930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exploration behind upper jaw","code_information":[{"code":"31040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exploration of frontal sinus","code_information":[{"code":"31070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of ethmoid sinus","code_information":[{"code":"31205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Nsl/sins ndsc w/artery lig","code_information":[{"code":"31241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1907.37,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1926.45,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1945.52,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1907.37,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of ethmoid sinus","code_information":[{"code":"31254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7714.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.16,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7562.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Endoscopy maxillary sinus","code_information":[{"code":"31267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7714.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.16,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7562.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Sinus endo w/balloon dil","code_information":[{"code":"31297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7714.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.16,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7562.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Biopsy elbow joint lining","code_information":[{"code":"24100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of elbow bursa","code_information":[{"code":"24105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"24110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove elbow lesion","code_information":[{"code":"24120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of arm tendon","code_information":[{"code":"24310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair elbow perc","code_information":[{"code":"24357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of tendon sheath","code_information":[{"code":"25000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incise flexor carpi radialis","code_information":[{"code":"25001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drainage of forearm lesion","code_information":[{"code":"25028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drainage of forearm bursa","code_information":[{"code":"25031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat forearm bone lesion","code_information":[{"code":"25035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc forearm les sc 3 cm/>","code_information":[{"code":"25071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc forearm tum deep 3 cm/>","code_information":[{"code":"25073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect forarm/wrist tum 3cm>","code_information":[{"code":"25078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of wrist capsule","code_information":[{"code":"25085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Biopsy of wrist joint","code_information":[{"code":"25100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise tendon forearm/wrist","code_information":[{"code":"25109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Augmentation lower jaw bone","code_information":[{"code":"21125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reduction of forehead","code_information":[{"code":"21137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Contour cranial bone lesion","code_information":[{"code":"21181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reconstr lwr jaw segment","code_information":[{"code":"21198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of jaw muscle/bone","code_information":[{"code":"21296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Open tx nose fx uncomplicatd","code_information":[{"code":"21325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Open tx nose fx w/skele fixj","code_information":[{"code":"21330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Open tx nose & septal fx","code_information":[{"code":"21335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Open tx septal fx w/wo stabj","code_information":[{"code":"21336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Open nasoethmoid fx w/o fixj","code_information":[{"code":"21338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Open nasoethmoid fx w/ fixj","code_information":[{"code":"21339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Opn tx nasomax fx w/fixj","code_information":[{"code":"21346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Opn tx dprsd zygomatic arch","code_information":[{"code":"21356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Opn tx dprsd malar fracture","code_information":[{"code":"21360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat mouth roof fracture","code_information":[{"code":"21421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat dental ridge fracture","code_information":[{"code":"21440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat lower jaw fracture","code_information":[{"code":"21454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drain neck/chest lesion","code_information":[{"code":"21501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drain chest lesion","code_information":[{"code":"21502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc neck les sc 3 cm/>","code_information":[{"code":"21552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc neck tum deep 5 cm/>","code_information":[{"code":"21554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc neck tum deep < 5 cm","code_information":[{"code":"21556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect neck tumor 5 cm/>","code_information":[{"code":"21558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc chest wall tumor w/ribs","code_information":[{"code":"21601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Hyoid myotomy & suspension","code_information":[{"code":"21685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Biopsy of breast open","code_information":[{"code":"19101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Nipple exploration","code_information":[{"code":"19110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise breast duct fistula","code_information":[{"code":"19112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of breast lesion","code_information":[{"code":"19120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excision breast lesion","code_information":[{"code":"19125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of Breast Tissue","code_information":[{"code":"19300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Partial Mastectomy","code_information":[{"code":"19301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Breast surgery procedure","code_information":[{"code":"19499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4195.85,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4195.85,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Bone biopsy open superficial","code_information":[{"code":"20240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Bone biopsy open deep","code_information":[{"code":"20245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Place ndl musc/tis for rt","code_information":[{"code":"20555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Application of pelvis brace","code_information":[{"code":"20662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of support implant","code_information":[{"code":"20680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of fascia for graft","code_information":[{"code":"20922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2211.05,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2211.05,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of jaw joint","code_information":[{"code":"21010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect face/scalp tum 2 cm/>","code_information":[{"code":"21016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excision of facial bone(s)","code_information":[{"code":"21026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Contour of face bone lesion","code_information":[{"code":"21029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise max/zygoma b9 tumor","code_information":[{"code":"21030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove exostosis mandible","code_information":[{"code":"21031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove exostosis maxilla","code_information":[{"code":"21032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise mandible lesion","code_information":[{"code":"21040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reconstruction of chin","code_information":[{"code":"21121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Optx of rib fx w/fixj scope","code_information":[{"code":"21811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect metatarsal tumor","code_information":[{"code":"28173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect phalanx of toe tumor","code_information":[{"code":"28175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc back les sc 3 cm/>","code_information":[{"code":"21931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc back tum deep 5 cm/>","code_information":[{"code":"21933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect back tum 5 cm/>","code_information":[{"code":"21936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc abdl tum deep < 5 cm","code_information":[{"code":"22900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc abdl tum deep 5 cm/>","code_information":[{"code":"22901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc abd les sc 3 cm/>","code_information":[{"code":"22903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Rad resect abd tumor 5 cm/>","code_information":[{"code":"22905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drain shoulder lesion","code_information":[{"code":"23030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drain shoulder bursa","code_information":[{"code":"23031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drain shoulder bone lesion","code_information":[{"code":"23035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc shoulder les sc 3 cm/>","code_information":[{"code":"23071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc shoulder tum deep 5 cm/>","code_information":[{"code":"23073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect shoulder tumor 5 cm/>","code_information":[{"code":"23078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Biopsy of shoulder joint","code_information":[{"code":"23100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drainage of arm lesion","code_information":[{"code":"23930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Drain arm/elbow bone lesion","code_information":[{"code":"23935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc arm/elbow les sc 3 cm/>","code_information":[{"code":"24071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Ex arm/elbow tum deep 5 cm/>","code_information":[{"code":"24073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of foot tendon(s)","code_information":[{"code":"28230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of foot tendon","code_information":[{"code":"28234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of big toe","code_information":[{"code":"28240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of foot fascia","code_information":[{"code":"28250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of foot and ankle","code_information":[{"code":"28262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of foot contracture","code_information":[{"code":"28270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release of toe joint each","code_information":[{"code":"28272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Fusion of toes","code_information":[{"code":"28280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Corrj halux rigdus w/o implt","code_information":[{"code":"28289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of ankle bone","code_information":[{"code":"28302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of big toe","code_information":[{"code":"28310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of toe","code_information":[{"code":"28312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair deformity of toe","code_information":[{"code":"28313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of sesamoid bone","code_information":[{"code":"28315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of metatarsals","code_information":[{"code":"28322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect enlarged toe tissue","code_information":[{"code":"28340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Resect enlarged toe","code_information":[{"code":"28341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair extra toe(s)","code_information":[{"code":"28344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair webbed toe(s)","code_information":[{"code":"28345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat midfoot fracture","code_information":[{"code":"28456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat toe fracture","code_information":[{"code":"28525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair toe dislocation","code_information":[{"code":"28645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of toe dislocation","code_information":[{"code":"28675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputation thru metatarsal","code_information":[{"code":"28805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputation toe & metatarsal","code_information":[{"code":"28810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laryngoscopy for treatment","code_information":[{"code":"31527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laryngoscopy w/biopsy","code_information":[{"code":"31535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laryngoscopy w/bx & op scope","code_information":[{"code":"31536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laryngoscopy w/exc of tumor","code_information":[{"code":"31540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Larynscop w/tumr exc + scope","code_information":[{"code":"31541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove vc lesion w/scope","code_information":[{"code":"31545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Larynscop remve cart + scop","code_information":[{"code":"31561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7714.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.53,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7714.16,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7562.9,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Laryngoscop w/vc inj + scope","code_information":[{"code":"31571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Largsc w/laser dstrj les","code_information":[{"code":"31572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Incision of windpipe","code_information":[{"code":"31610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Surgery/speech prosthesis","code_information":[{"code":"31611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Puncture/clear windpipe","code_information":[{"code":"31612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair windpipe opening","code_information":[{"code":"31613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Bronch ebus samplng 1/2 node","code_information":[{"code":"31652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Bronch ebus samplng 3/> node","code_information":[{"code":"31653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3995.36,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4035.32,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4075.27,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3995.36,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove windpipe lesion","code_information":[{"code":"31785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":6470.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.24,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6470.68,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6343.8,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Closure of windpipe lesion","code_information":[{"code":"31820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair of windpipe defect","code_information":[{"code":"31825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3552.91,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3588.44,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3623.97,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3552.91,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Reremove wrist tendon lesion","code_information":[{"code":"25112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Excise wrist tendon sheath","code_information":[{"code":"25118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Remove forearm foreign body","code_information":[{"code":"25248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Release wrist/forearm tendon","code_information":[{"code":"25295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat Fx Distal Radial","code_information":[{"code":"25606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Pin ulnar styloid fracture","code_information":[{"code":"25651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Pin radioulnar dislocation","code_information":[{"code":"25671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5543.0,"maximum":7931.41,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7775.89,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1723.15,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1740.39,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1757.62,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1723.15,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc hand les sc 1.5 cm/>","code_information":[{"code":"26111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Exc hand tum deep 1.5 cm/>","code_information":[{"code":"26113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1769.88,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1769.88,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Rad resect hand tumor 3 cm/>","code_information":[{"code":"26118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3112.75,"maximum":5672.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3143.87,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3175.0,"additional_payer_notes":"APC"},{"payer_name":"Caterpillar","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3112.75,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Revision of finger","code_information":[{"code":"26499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Repair muscles of hand","code_information":[{"code":"26591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Pin hand dislocation","code_information":[{"code":"26676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Pin finger fracture each","code_information":[{"code":"26756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3506.34,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5543.0}]}]},{"description":"Pin finger dislocation","code_information":[{"code":"26776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3506.34,"maximum":5672.0,"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":5672.0},{