{"hospital_name": "Westover Hills Baptist Hospital", "last_updated_on": "2026-04-02", "version": "3.0.0", "pid": "2901236048", "rid": "10205", "location_name": ["Westover Hills Baptist Hospital"], "hospital_address": ["3011 W Loop 1604 N, San Antonio, TX 78251"], "type_2_npi": ["1831970532"], "license_information": {"license_number": "000114", "state": "TX"}, "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": "11-DEOXYXORTISL", "code_information": [{"code": "82634", "type": "CPT"}, {"code": "7252517", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 579.0, "discounted_cash": 434.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "17-HYDROXY PREGNENOLONE", "code_information": [{"code": "84143", "type": "CPT"}, {"code": "7258414", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 252.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3D IMAGING NO POSTPROCESS", "code_information": [{"code": "76376", "type": "CPT"}, {"code": "4910010", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"gross_charge": 3030.0, "discounted_cash": 2272.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3D IMAGING W POSTPROCESS", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "4616377", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"gross_charge": 1906.0, "discounted_cash": 1429.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "3D IMAGING W POSTPROCESS", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "4917637", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"gross_charge": 1906.0, "discounted_cash": 1429.5, "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": 3030.0, "discounted_cash": 2272.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "A-2 MACROGLOBULIN", "code_information": [{"code": "83883", "type": "CPT"}, {"code": "7253868", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 365.0, "discounted_cash": 273.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 10% 1L TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5413180", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 683.0, "discounted_cash": 512.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25% D25 2L TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412007", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 361.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25% D25 EL/CA 1LTPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412047", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 277.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25% D25 EL/CA 2LTPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412006", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 490.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25% D5 1L TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412034", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 208.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25% D5 2L TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412024", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 501.0, "discounted_cash": 375.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25% D5 EL/CA 1L TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412011", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 208.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "AA 4.25%D5 EL/CA 2L TPN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412012", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 558.0, "discounted_cash": 418.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300003", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 72.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300003", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 72.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR/DOLUT/LAMIV TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 486.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABACAVIR/DOLUT/LAMIV TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300023", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 486.75, "setting": "outpatient", "billing_class": "facility"}]}, {"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": 15942.0, "discounted_cash": 11956.5, "setting": "outpatient", "billing_class": "facility"}]}, {"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": 15942.0, "discounted_cash": 11956.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABD AORTOGRPHY BY SERIAL", "code_information": [{"code": "75625", "type": "CPT"}, {"code": "4615627", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 12313.0, "discounted_cash": 9234.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABD AORTOGRPHY BY SERIAL", "code_information": [{"code": "75625", "type": "CPT"}, {"code": "4915627", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 12313.0, "discounted_cash": 9234.75, "setting": "outpatient", "billing_class": "facility"}]}, {"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": 4121.0, "discounted_cash": 3090.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABD ART/VEN FLOW LTD", "code_information": [{"code": "93976", "type": "CPT"}, {"code": "5062017", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"gross_charge": 2201.0, "discounted_cash": 1650.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "4919083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7369.0, "discounted_cash": 5526.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", 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"outpatient", "billing_class": "facility"}]}, {"description": "ABDOMEN 2 VIEWS", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "4904019", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 1379.0, "discounted_cash": 1034.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABDOMEN 2+VWS SNGL VW CHEST", "code_information": [{"code": "74022", "type": "CPT"}, {"code": "4904022", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 2811.0, "discounted_cash": 2108.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABDOMEN 3/+ VIEWS", "code_information": [{"code": "74021", "type": "CPT"}, {"code": "4904021", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 2165.0, "discounted_cash": 1623.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABDOMEN/CHEST DET FORBDY", "code_information": [{"code": "76010", "type": "CPT"}, {"code": "4904030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 2317.0, "discounted_cash": 1737.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABG W CALC O2 SAT", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "5501806", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 1107.0, "discounted_cash": 830.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABL 1 KINASE VARIANTS", "code_information": [{"code": "81170", "type": "CPT"}, {"code": "7120050", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 1810.0, "discounted_cash": 1357.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABLATION-AV NODE", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "4610650", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"gross_charge": 30019.0, "discounted_cash": 22514.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ABLATN RENL TUMORS CRYO", "code_information": [{"code": "5050593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19834.0, "discounted_cash": 14875.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300025", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACARBOSE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300005", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACARBOSE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300005", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACEBUTOLOL 200MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300008", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACEBUTOLOL 200MG CAP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300008", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETABULR COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6730.0, "discounted_cash": 5047.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}, {"code": "4100408", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "discounted_cash": 378.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAM PER1ML CMPDLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314026", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAM PER1ML CMPDLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314026", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMI UPTO 500MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "5318004", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 303.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMI UPTO 500MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "5318004", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 303.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMID 500MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMID 500MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300102", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300094", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300094", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300098", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETIC ACID 2% 15ML OT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330016", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 298.0, "discounted_cash": 223.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ACETIC ACID 2% 15ML OT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330016", "type": "CDM"}, 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"setting": "outpatient", "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304665", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304665", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304664", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, 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VARIANT", "code_information": [{"code": "81241", "type": "CPT"}, {"code": "7259207", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 1422.0, "discounted_cash": 1066.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FA PED PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315238", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FA PED PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315238", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FACIAL BONES 2VW MAX", "code_information": [{"code": "70140", "type": "CPT"}, {"code": "4900140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 2599.0, "discounted_cash": 1949.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FACIAL BONES 3VW MIN", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "4900150", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 3544.0, "discounted_cash": 2658.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FACTOR 8 RECOM PER IU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7192", "type": "HCPCS"}, {"code": "5320693", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FACTOR 9 CMPLX PER IU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7194", "type": 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1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335572", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 2025.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLUOROURACIL PER500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9190", "type": "HCPCS"}, {"code": "5320708", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 123.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLUOROURACIL PER500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9190", "type": "HCPCS"}, {"code": "5320708", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 123.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "FLUOXETINE 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"CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS LNR BEAR HUM VITA E ZIM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23995.0, "discounted_cash": 17996.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS LV LD W/PM OR AICD", "code_information": [{"code": "4613225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16864.0, "discounted_cash": 12648.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS N/R 70/30 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS N/R 70/30 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321270", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS NPH HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321262", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS NPH HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321262", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": 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"setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD AT", "code_information": [{"code": "4613206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 53292.0, "discounted_cash": 39969.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD VE", "code_information": [{"code": "4613207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 56680.0, "discounted_cash": 42510.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INS/RPL PMW/TRNSV LD A-V", "code_information": [{"code": "4613208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 62753.0, "discounted_cash": 47064.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18810.0, "discounted_cash": 14107.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12123.0, "discounted_cash": 9092.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR ZIMMER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11998.0, "discounted_cash": 8998.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL STD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7375.0, "discounted_cash": 5531.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT KNEE REVISION SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21147.0, "discounted_cash": 15860.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT KNEE TS REV STRYKR CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22731.0, "discounted_cash": 17048.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT PHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23503.0, "discounted_cash": 17627.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT POLY ANKLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42799.0, "discounted_cash": 32099.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT SCRW PLT LCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1114.0, "discounted_cash": 835.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT SWANGANZ CATHETER", "code_information": [{"code": "93503", "type": "CPT"}, {"code": "4613535", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"gross_charge": 4551.0, "discounted_cash": 3413.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT SWANGANZ CATHETER", "code_information": [{"code": "93503", "type": "CPT"}, {"code": "4613535", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"gross_charge": 4551.0, "discounted_cash": 3413.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "4613202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4924.0, "discounted_cash": 3693.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "4917772", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4924.0, "discounted_cash": 3693.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "5057576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4924.0, "discounted_cash": 3693.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "5066639", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4924.0, "discounted_cash": 3693.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL ANY DJO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8458.0, "discounted_cash": 6343.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSERT/BEARING POLY EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11983.0, "discounted_cash": 8987.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "4308374", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 1879.0, "discounted_cash": 1409.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7270097", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 1879.0, "discounted_cash": 1409.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSITU 1ST PRB CMPT ASSI", "code_information": [{"code": "88367", "type": "CPT"}, {"code": "4300078", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 1960.0, "discounted_cash": 1470.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "INSITU 1ST PRB MANUAL", "code_information": [{"code": "88368", "type": "CPT"}, {"code": "4308368", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"gross_charge": 1372.0, "discounted_cash": 1029.0, "setting": "outpatient", 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SQ CM", "code_information": [{"code": "Q4158", "type": "HCPCS"}, {"code": "4023324", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 803.0, "discounted_cash": 602.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KERECIS OMEGA3 PER SQ CM", "code_information": [{"code": "Q4158", "type": "HCPCS"}, {"code": "4023326", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 507.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KERECIS OMEGA3 PER SQ CM", "code_information": [{"code": "Q4158", "type": "HCPCS"}, {"code": "4023326", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 676.0, "discounted_cash": 507.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "KETAMINE 100MG/ML 5ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": 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"RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 154.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 750MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306428", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 154.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN PER250MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1956", "type": "HCPCS"}, {"code": "5321709", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 135.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN PER250MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1956", "type": "HCPCS"}, {"code": "5321709", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 135.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOFLOXACN PED PER1MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321717", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVONORG(MIRENA)52MG IUD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7298", "type": "HCPCS"}, {"code": "5336185", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9275.0, "discounted_cash": 6956.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVONORG(MIRENA)52MG IUD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7298", "type": "HCPCS"}, {"code": "5336185", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 9275.0, "discounted_cash": 6956.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVONORGESTREL 1.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306433", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 179.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVONORGESTREL 1.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306433", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 179.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .025MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, 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1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306451", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .075MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306454", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .075MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306454", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .088MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306435", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .088MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306435", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .112MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306456", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": 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"billing_class": "facility"}]}, {"description": "NA ACETATE NEO CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315837", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA ACETATE NS 30ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5322677", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA ACETATE2MEQ/ML 20MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324130", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 16.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BENZ/NA PHENYL50ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324134", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 42089.0, "discounted_cash": 31566.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BICARB 4%5ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324138", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 49.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BICARB 4.2% 5ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324137", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": 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"type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 64.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BICARB NEO CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315826", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BICARB NEO CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315826", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA BICARB PED4.2% IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324141", "type": 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CL 1GM TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310833", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA CL 1GM TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310833", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA FERR GLUC PER12.5MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2916", "type": "HCPCS"}, {"code": "5322669", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 51.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA FERR GLUC PER12.5MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": 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"type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337310", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA PHOSPHATE NEO CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315827", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 31.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA PHOSPHATE NEO CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315827", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 31.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA PHOSPHATE PER 1ML IJ", 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"outpatient", "billing_class": "facility"}]}, {"description": "NA/K PHOS 250/280/160 PK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307970", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/K PHOS PED DS CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315831", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/K PHOS PED DS CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315831", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/POT/PHOS NEUT TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309686", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NA/POT/PHOS NEUT TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309686", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .65% 45ML NASAL SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332385", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .65% 45ML NASAL SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332385", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .65% 45ML NASL IS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332396", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .65% 45ML NASL IS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332396", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .9% 10ML IJ", "code_information": [{"code": "A4216", "type": "HCPCS"}, {"code": "5324194", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .9% 10ML PFS IJ", "code_information": [{"code": "A4216", "type": "HCPCS"}, {"code": "5324200", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 25.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .9% 15ML IH", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337303", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .9% 15ML IH", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337303", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL .9% 3ML PFS IJ", "code_information": [{"code": "A4216", "type": "HCPCS"}, {"code": "5324201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.20 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412627", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 123.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.20 250ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412626", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 123.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.45 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412625", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 179.0, "discounted_cash": 134.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.45 250ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412616", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 123.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "NACL 0.45 500ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412620", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, 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"A9150", "type": "HCPCS"}, {"code": "5331794", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PE NASAL .25% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331794", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PE NASAL .5% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331808", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PE NASAL .5% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331808", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": 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NASAL 1% 30ML DR IS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331814", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PE/CYCLOPENT 1-.2%2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331842", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 161.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PE/CYCLOPENT1-.2% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331843", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 547.0, "discounted_cash": 410.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEG LOCKING IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1712.0, "discounted_cash": 1284.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM PER 0.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}, {"code": "5323112", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4502.0, "discounted_cash": 3376.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM PER 0.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}, {"code": "5323112", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4502.0, "discounted_cash": 3376.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM-JMDB PER 0.5MGIJ", "code_information": [{"code": "Q5108", "type": "HCPCS"}, {"code": "5323097", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2928.0, "discounted_cash": 2196.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM-JMDB PER 0.5MGIJ", "code_information": [{"code": "Q5108", "type": "HCPCS"}, {"code": "5323097", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2928.0, "discounted_cash": 2196.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PELVIS 1 VIEW", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "4902170", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 1301.0, "discounted_cash": 975.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PELVIS 2 VIEWS", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "4902175", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 671.0, "discounted_cash": 503.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PELVIS MIN 3 VWS", "code_information": [{"code": "72190", "type": "CPT"}, {"code": "4902190", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 1334.0, "discounted_cash": 1000.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMBROLIZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}, {"code": "5323115", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 303.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMBROLIZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}, {"code": "5323115", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 303.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED (ACCORD) PER 10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}, {"code": "5323116", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED (ACCORD) PER 10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}, {"code": "5323116", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED (HOSPIRA) PER10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}, {"code": "5323114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 69.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED (HOSPIRA) PER10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}, {"code": "5323114", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 69.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED (SANDOZ) PER 10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}, {"code": "5323117", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 443.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED (SANDOZ) PER 10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}, {"code": "5323117", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 443.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}, {"code": "5323099", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 390.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEMETREXED PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}, {"code": "5323099", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 390.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G BE/PR PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}, {"code": "5323135", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 23.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G BE/PR PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}, {"code": "5323135", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 23.25, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G BENZ PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "5323121", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 54.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G BENZ PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "5323121", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 54.0, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G K TO 600KU IVPB IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "5323150", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G K TO 600KU IVPB IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "5323150", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 27.75, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G K UPTO 600KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "5323151", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PEN G K UPTO 600KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "5323151", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "outpatient", "billing_class": "facility"}]}, {"description": "PENICILLIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, 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