{"hospital_name": "Doctors Medical Center of Modesto, Inc.", "last_updated_on": "2026-04-08", "version": "3.0.0", "pid": "1514755941", "rid": "11229", "location_name": ["Doctors Medical Center of Modesto"], "hospital_address": ["1441 Florida Ave, Modesto, CA 95350"], "type_2_npi": ["1184654923"], "license_information": {"license_number": "030000026", "state": "CA"}, "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": "Geoffrey Vines"}, "standard_charge_information": [{"description": "14-3-3 PROTEIN", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253490", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 13.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 18.0, "discounted_cash": 13.5, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "14-3-3 PROTEIN/2", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253489", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 305.93, "discounted_cash": 229.45, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 305.93, "discounted_cash": 229.45, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "3D IMAGING W POSTPROCESS", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "4917637", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"gross_charge": 1563.0, "discounted_cash": 1172.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1563.0, "discounted_cash": 1172.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3D IMAGING W POSTPROCESS", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "5057637", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 1260.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1680.0, "discounted_cash": 1260.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3D IMAGNG NO POSTPROCESS", "code_information": [{"code": "76376", "type": "CPT"}, {"code": "5057636", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"gross_charge": 1349.0, "discounted_cash": 1011.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1349.0, "discounted_cash": 1011.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 10% 500ML TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5413175", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 3459.0, "discounted_cash": 2594.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 3459.0, "discounted_cash": 2594.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25% D10 1L TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412018", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 1434.0, "discounted_cash": 1075.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1434.0, "discounted_cash": 1075.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR 20MG/ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5314005", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 90.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 121.0, "discounted_cash": 90.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR 20MG/ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5314005", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 90.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 121.0, "discounted_cash": 90.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300003", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 291.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 388.0, "discounted_cash": 291.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300003", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 291.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 388.0, "discounted_cash": 291.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABATACEPT PER 10MG IV IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5318036", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 82.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 110.0, "discounted_cash": 82.5, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "JA"}, {"description": "ABATACEPT PER 10MG IV IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5318036", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 82.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 110.0, "discounted_cash": 82.5, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "JA"}, {"description": "ABD AORTA W/BI LWR EXT", "code_information": [{"code": "75630", "type": "CPT"}, {"code": "4615631", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 37450.0, "discounted_cash": 28087.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 37450.0, "discounted_cash": 28087.5, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "ABD AORTA W/BI LWR EXT", "code_information": [{"code": "75630", "type": "CPT"}, {"code": "4915631", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 38202.0, "discounted_cash": 28651.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 38202.0, "discounted_cash": 28651.5, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "ABD AORTOGRPHY BY SERIAL", "code_information": [{"code": "75625", "type": "CPT"}, {"code": "4615627", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 31353.0, "discounted_cash": 23514.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 31353.0, "discounted_cash": 23514.75, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "ABD AORTOGRPHY BY SERIAL", "code_information": [{"code": "75625", "type": "CPT"}, {"code": "4915627", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 31331.0, "discounted_cash": 23498.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 31331.0, "discounted_cash": 23498.25, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "ABD ART/VEN FLOW ABD COMP", "code_information": [{"code": "93975", "type": "CPT"}, {"code": "5062015", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"gross_charge": 3743.0, "discounted_cash": 2807.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 3743.0, "discounted_cash": 2807.25, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "ABD ART/VEN FLOW LTD", "code_information": [{"code": "93976", "type": "CPT"}, {"code": "3125010", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"gross_charge": 621.0, "discounted_cash": 465.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 621.0, "discounted_cash": 465.75, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "ABD ART/VEN FLOW LTD", "code_information": [{"code": "93976", "type": "CPT"}, {"code": "5062017", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"gross_charge": 2105.0, "discounted_cash": 1578.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 2105.0, "discounted_cash": 1578.75, "setting": "outpatient", "billing_class": "facility"}], 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"modifiers": "TC"}, {"description": "ABG W O2 DIRECT", "code_information": [{"code": "82805", "type": "CPT"}, {"code": "5500152", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 2212.0, "discounted_cash": 1659.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 2212.0, "discounted_cash": 1659.0, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "ABIRATERONE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300019", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 868.0, "discounted_cash": 651.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 868.0, "discounted_cash": 651.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABIRATERONE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300019", "type": "CDM"}, {"code": 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"billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 149.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 199.0, "discounted_cash": 149.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300025", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 149.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 199.0, "discounted_cash": 149.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACARBOSE 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300004", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, "discounted_cash": 101.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 135.0, "discounted_cash": 101.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACARBOSE 25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300004", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, "discounted_cash": 101.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 135.0, "discounted_cash": 101.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACARBOSE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300005", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 69.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 93.0, "discounted_cash": 69.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACARBOSE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300005", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 69.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 93.0, "discounted_cash": 69.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACEBUTOLOL 200MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300008", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACEBUTOLOL 200MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5300008", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETABULR COMP", "code_information": [{"code": "8131000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11214.0, "discounted_cash": 8410.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 11214.0, "discounted_cash": 8410.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAM PER1ML CMPDLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5314026", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 123.75, "setting": "inpatient", "billing_class": "facility"}, 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"billing_class": "facility"}]}, {"description": "INSERT KNEE REVISION SN CL", "code_information": [{"code": "4012883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24654.0, "discounted_cash": 18490.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 24654.0, "discounted_cash": 18490.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT PHALANGEAL", "code_information": [{"code": "8137727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18958.0, "discounted_cash": 14218.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 18958.0, "discounted_cash": 14218.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT POLY ANKLE", "code_information": [{"code": "8137724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11547.0, "discounted_cash": 8660.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 11547.0, "discounted_cash": 8660.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT SCRW PLT LCK", "code_information": [{"code": "8137725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 962.0, "discounted_cash": 721.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 962.0, "discounted_cash": 721.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "4917772", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7949.0, "discounted_cash": 5961.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 7949.0, "discounted_cash": 5961.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "5057576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 2100.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 2800.0, "discounted_cash": 2100.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL", "code_information": [{"code": "8137720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29298.0, "discounted_cash": 21973.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 29298.0, "discounted_cash": 21973.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT/BEAR ALL POLY TJO CL", "code_information": [{"code": "4013486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11849.0, "discounted_cash": 8886.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 11849.0, "discounted_cash": 8886.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT/BEAR HIGH GLOBUS CL", "code_information": [{"code": "4013240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12976.0, "discounted_cash": 9732.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 12976.0, "discounted_cash": 9732.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSIT E ADD PRB CMP ASST", "code_information": [{"code": "88373", "type": "CPT"}, {"code": "4308373", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 41.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 55.0, "discounted_cash": 41.25, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7270097", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 184.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 246.0, "discounted_cash": 184.5, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "INSITU 1ST PRB CMPT ASSI", "code_information": [{"code": "88367", "type": "CPT"}, {"code": "4300078", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 412.81, "discounted_cash": 309.61, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 412.81, "discounted_cash": 309.61, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "INSITU 1ST PRB MANUAL", "code_information": [{"code": "88368", "type": "CPT"}, {"code": "4308368", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 412.81, "discounted_cash": 309.61, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 412.81, "discounted_cash": 309.61, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "INSITU ADD PROBE MANUAL", "code_information": [{"code": "88369", "type": "CPT"}, {"code": "4308391", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 97.82, "discounted_cash": 73.37, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 97.82, "discounted_cash": 73.37, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "INSITU EA ADD SNGL PROBE", "code_information": [{"code": "88364", "type": "CPT"}, {"code": "4308389", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 112.45, "discounted_cash": 84.34, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 112.45, "discounted_cash": 84.34, "setting": "outpatient", "billing_class": "facility"}], "modifiers": "TC"}, {"description": "INSRT BEAR PLY CNVNT HGH SN CL", "code_information": [{"code": "4012909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12326.0, "discounted_cash": 9244.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 12326.0, "discounted_cash": 9244.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSRT BEARNG TIB RP AESCULP CL", "code_information": [{"code": "4013344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11638.0, "discounted_cash": 8728.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 11638.0, "discounted_cash": 8728.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSRT BILI DRAIN EXT", "code_information": [{"code": "4917760", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11008.0, "discounted_cash": 8256.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 11008.0, "discounted_cash": 8256.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSRT BILI DRAIN INT/EXT", "code_information": [{"code": "4917534", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13516.0, "discounted_cash": 10137.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 13516.0, "discounted_cash": 10137.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSRT CVAD W PRT 5YRS>", "code_information": [{"code": "4916571", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32798.0, "discounted_cash": 24598.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 32798.0, "discounted_cash": 24598.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSRT HUM LINR BEAR STRYK CL", "code_information": [{"code": "4013025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20632.0, "discounted_cash": 15474.0, "setting": "inpatient", 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{"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12525.0, "discounted_cash": 9393.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 12525.0, "discounted_cash": 9393.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSRT LNR BEARNG HUMERL DJO CL", "code_information": [{"code": "4013426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15798.0, "discounted_cash": 11848.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 15798.0, "discounted_cash": 11848.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSRT NONTUNNL CV CTH 5>", "code_information": [{"code": "4616556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6445.0, "discounted_cash": 4833.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 6445.0, "discounted_cash": 4833.75, "setting": "outpatient", 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458.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 611.0, "discounted_cash": 458.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5306430", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 161.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 215.0, "discounted_cash": 161.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5306430", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 161.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 215.0, "discounted_cash": 161.25, "setting": "outpatient", "billing_class": "facility"}]}, 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"RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 184.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 246.0, "discounted_cash": 184.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 750MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5306428", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 184.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 246.0, "discounted_cash": 184.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVONORGESTREL 1.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5306433", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 219.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 293.0, "discounted_cash": 219.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVONORGESTREL 1.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5306433", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 219.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 293.0, "discounted_cash": 219.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .025MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5306447", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .025MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": 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"NA BICARBONATE 325MG TB", "code_information": [{"code": "5310806", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 108.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 144.0, "discounted_cash": 108.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BICARBONATE 650MG TB", "code_information": [{"code": "5310810", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BICARBONATE 650MG TB", "code_information": [{"code": "5310810", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BIPHOSPHATE ADULT RE", "code_information": [{"code": "5338726", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BIPHOSPHATE ADULT RE", "code_information": [{"code": "5338726", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BIPHOSPHATE PED RE", "code_information": [{"code": "5338730", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BIPHOSPHATE PED RE", "code_information": [{"code": "5338730", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA CITRA/CITRC AC30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5316355", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 133.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 178.0, "discounted_cash": 133.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA CITRA/CITRC AC30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5316355", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 133.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 178.0, "discounted_cash": 133.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA CL 1GM TB", "code_information": [{"code": "5310833", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA CL 1GM TB", "code_information": [{"code": "5310833", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA FERR GLUC PER12.5MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5322669", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 119.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 159.0, "discounted_cash": 119.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA FERR GLUC PER12.5MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5322669", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 119.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 159.0, "discounted_cash": 119.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA HYPOCHL .25% 480ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5337305", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 121.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 162.0, "discounted_cash": 121.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA HYPOCHL.125% 480ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5337310", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 121.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 162.0, "discounted_cash": 121.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA PHOSPHATE3MM/ML15MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5324257", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 136.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 182.0, "discounted_cash": 136.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA THIOSULFATE PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5324298", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA THIOSULFATE PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5324298", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/K PHOS 250/280/160 PK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5307970", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 135.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 180.0, "discounted_cash": 135.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/K PHOS 250/280/160 PK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5307970", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 135.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 180.0, "discounted_cash": 135.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/POT/PHOS NEUT TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5309686", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 44.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 59.0, "discounted_cash": 44.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/POT/PHOS NEUT TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5309686", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 44.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 59.0, "discounted_cash": 44.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .65% 45ML NASAL SP", "code_information": [{"code": "5332385", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 130.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 174.0, "discounted_cash": 130.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .65% 45ML NASAL 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"outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.45 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412625", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 171.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 228.0, "discounted_cash": 171.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.45 250ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412616", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 93.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 125.0, "discounted_cash": 93.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.45 500ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412620", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 242.0, "discounted_cash": 181.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 242.0, "discounted_cash": 181.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412670", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412670", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 100ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412640", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 100ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412640", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 250ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412655", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 250ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412655", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 500ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412665", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 941.0, "discounted_cash": 705.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 941.0, "discounted_cash": 705.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 500ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412665", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 941.0, "discounted_cash": 705.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 941.0, "discounted_cash": 705.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 50ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412635", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 50ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412635", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 MB+ 100ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412642", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 185.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 247.0, "discounted_cash": 185.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9 MB+ 100ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5412642", "type": "CDM"}, {"code": "636", "type": "RC"}], 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41.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 55.0, "discounted_cash": 41.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5311192", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 180.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 241.0, "discounted_cash": 180.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5311192", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 180.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 241.0, "discounted_cash": 180.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5311190", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 228.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 304.0, "discounted_cash": 228.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5311190", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 228.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 304.0, "discounted_cash": 228.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5311191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 341.0, "discounted_cash": 255.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 341.0, "discounted_cash": 255.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5311191", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 341.0, "discounted_cash": 255.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 341.0, "discounted_cash": 255.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN PER 6MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "5324420", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2000.0, "discounted_cash": 1500.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 2000.0, "discounted_cash": 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{"code": "3114610", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 447.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 597.0, "discounted_cash": 447.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURFACTANT ADMIN TUBE", "code_information": [{"code": "94610", "type": "CPT"}, {"code": "5504610", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"gross_charge": 2111.0, "discounted_cash": 1583.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 2111.0, "discounted_cash": 1583.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL I EA ADD 15 MIN", "code_information": [{"code": "3203551", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5592.0, "discounted_cash": 4194.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 5592.0, "discounted_cash": 4194.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL I EA ADD 15 MIN", "code_information": [{"code": "3213551", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6434.0, "discounted_cash": 4825.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 6434.0, "discounted_cash": 4825.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL I INT 30 MIN", "code_information": [{"code": "3203550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12582.0, "discounted_cash": 9436.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 12582.0, "discounted_cash": 9436.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL I INT 30 MIN", "code_information": [{"code": "3213550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14481.0, "discounted_cash": 10860.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 14481.0, "discounted_cash": 10860.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL II EA ADD 15 MIN", "code_information": [{"code": "3203553", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6430.0, "discounted_cash": 4822.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 6430.0, "discounted_cash": 4822.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL II EA ADD 15 MIN", "code_information": [{"code": "3213553", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7175.0, "discounted_cash": 5381.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 7175.0, "discounted_cash": 5381.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL II INT 30 MIN", "code_information": [{"code": "3203552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16367.0, "discounted_cash": 12275.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 16367.0, "discounted_cash": 12275.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL II INT 30 MIN", "code_information": [{"code": "3213552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 15980.0, "discounted_cash": 11985.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 15980.0, "discounted_cash": 11985.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL III EA ADD 15 MIN", "code_information": [{"code": "3203555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7014.0, "discounted_cash": 5260.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 7014.0, "discounted_cash": 5260.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL III EA ADD 15 MIN", "code_information": [{"code": "3213555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7827.0, "discounted_cash": 5870.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 7827.0, "discounted_cash": 5870.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL III INT 30 MIN", "code_information": [{"code": "3203554", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 15780.0, "discounted_cash": 11835.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 15780.0, "discounted_cash": 11835.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL III INT 30 MIN", "code_information": [{"code": "3213554", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19549.0, "discounted_cash": 14661.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 19549.0, "discounted_cash": 14661.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL IV EA ADD 15 MIN", "code_information": [{"code": "3203557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8684.0, "discounted_cash": 6513.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 8684.0, "discounted_cash": 6513.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL IV EA ADD 15 MIN", "code_information": [{"code": "3213557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8480.0, "discounted_cash": 6360.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 8480.0, "discounted_cash": 6360.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL IV INT 30 MIN", "code_information": [{"code": "3203556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19708.0, "discounted_cash": 14781.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 19708.0, "discounted_cash": 14781.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG LEVEL IV INT 30 MIN", "code_information": [{"code": "3213556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19240.0, "discounted_cash": 14430.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 19240.0, "discounted_cash": 14430.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC I", "code_information": [{"code": "4540224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC I", "code_information": [{"code": "6296000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 209.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 279.0, "discounted_cash": 209.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC II", "code_information": [{"code": "4540225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 859.0, "discounted_cash": 644.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 859.0, "discounted_cash": 644.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC II", "code_information": [{"code": "6296001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2787.0, "discounted_cash": 2090.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 2787.0, "discounted_cash": 2090.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC III", "code_information": [{"code": "4540226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1587.0, "discounted_cash": 1190.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1587.0, "discounted_cash": 1190.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC III", "code_information": [{"code": "6296002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4122.0, "discounted_cash": 3091.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 4122.0, "discounted_cash": 3091.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6100400", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 611.0, "discounted_cash": 458.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 611.0, "discounted_cash": 458.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6110010", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 631.0, "discounted_cash": 473.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 631.0, "discounted_cash": 473.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6110400", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6166000", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 611.0, "discounted_cash": 458.25, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 611.0, "discounted_cash": 458.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6820001", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"gross_charge": 1938.0, "discounted_cash": 1453.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1938.0, "discounted_cash": 1453.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6820001", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 1938.0, "discounted_cash": 1453.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1938.0, "discounted_cash": 1453.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6920401", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6920401", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6100402", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 1221.0, "discounted_cash": 915.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1221.0, "discounted_cash": 915.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6110011", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 1129.0, "discounted_cash": 846.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1129.0, "discounted_cash": 846.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6110402", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 561.0, "discounted_cash": 420.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 561.0, "discounted_cash": 420.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6166001", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 1221.0, "discounted_cash": 915.75, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 1221.0, "discounted_cash": 915.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6820002", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"gross_charge": 4508.0, "discounted_cash": 3381.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 4508.0, "discounted_cash": 3381.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6820002", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 4508.0, "discounted_cash": 3381.0, "setting": "inpatient", "billing_class": "facility"}, {"gross_charge": 4508.0, "discounted_cash": 3381.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", 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